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Home My WebLink AboutBLDG-23-001716 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -it ` CITY !YARMOUTH MA DATE September 29,202 PERMIT# BLDG-23-001716 JOBSITE ADDRESS 116 JOYCE ST OWNER'S NAME (PUTNAM EUNICE,P TR G OWNER ADDRESS (THE EUNICE P PUTNAM LVG TRUST 16 JOYCE ST SOUTH YARMOUTH MA 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME (William Pizzano I LICENSE# 113748 I SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION❑#I I PARTNERSHIP ❑#I ILLC ❑#1 COMPANY NAME: IWILLIAM E PIZZANO I ADDRESS. 151 Maple, I CITY (Rockland (STATE IMA I ZIP 102370 I TEL I FAX 1 I CELL I 1 EMAIL Iwill.pizzanola7,gmail.com MASS+CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -.0• PA i 111 i H MA DATE 9 /7n f 2: PERMIT# — 1 l /L• EP 2 9 TE DlRESS I( S)VCk_ Z� I .I OWNER'S NAME IJ«v 1 B iJ I G D E p9 ` :4D ESS J VYcL 'S ) TEL FAX P T uCCUI-ANu TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:231, RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO,. APPLIANCES"1 FLOORS—t BSM 1 2 3 4 5 6 7 Y 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER • ROOM I SPACE HEATER ROC)F TOP UNIT UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1.1 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LoBILITY INSURANCE POLICY Et OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed undar the permit issued for this application will be in compliance with all Pent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1.119,( � � �l " 0 PLUMBER-GASFITTER NAME LICENSE# SIGNA MP j MGF❑ JP 0 JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME wit.L.L A firy P ZZf1 NO ADDRESS .6 1 Jr IlP CITY - �I n f\ STATE RIft ZIP ( 23re TEL 7g1--z6'f-�ln /Z_ FAX CELL 7X I EMAIL JLtL P ��1 -�.�1°W k f C1✓I 1,