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HomeMy WebLinkAboutBLDG-21-03837 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 11,2021 PERMIT# BLDG-21-003837 `-,' JOBSITE ADDRESS 17 SUMMER ST OWNER'S NAME DICK JOSEPH W G OWNER ADDRESS MAYKEL MICHELE A 17 SUMMER ST YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER , BOOSTER , CONVERSION BURNER , COOK STOVE 1 DIRECT VENT HEATER , DRYER , FIREPLACE , FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER . LABORATORY COCKS , MAKEUP AIR UNIT , OVEN POOL HEATER ROOM I 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❑ BOND ❑ 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 Peter Hassett LICENSE# 11682 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PETER J HASSETT ADDRESS. 8 Skipper Lane,Hassett Plumbing&Heating Inc. CITY Yarmouth Port STATE MA ZIP 02675 TEL :9-37 — Z 115 FAX CELL EMAIL peterihassettangmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES {'� _ /1'� Yes No �-i-/s nil S' l�(��� I NSr1£C.i£O THIS APPLICATION SERVES AS THE PERMIT 1/Act p5Qvtl LT-Of el0G-/9-eet e5EE:$ PERMIT# Gi24 fi PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Malabl CITY Yarmouth MA DATE 1/712021 PERMIT# +3c l Z —00 JOBSITE ADDRESS 17 Sumer St OWNER'S NAME Joseph Dick OWNER ADDRESS Joseph Dick TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL - PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR i FURNACE _ — GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER —WATER 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 OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW C E V E I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE LIABILITY INSURANCE POLICY - OTHER TYPE INDEMNITY BON IL OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Ch to20218 Massachusetts General Laws,and that my signature on this permit application waives this requirement. BLDING DEp""''•- ey. ARtMEN' CHECK ONE ONLY: 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 9,1;0 accurate tq the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp c nt rtine vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. < PLUMBER-GASFITTER NAME Peter J.Hassett J LICENSE#1 11682 SI NATURE MP - MGF , JP J JGF r1 LPG! CORPORATION . ''# 3506 PARTNERSHIP # LLC # COMPANY NAME:[Hassett Plumbing and Heating Inc. ADDRESS 8 Ski p r Lane CITY Yarmouth Port STATE MAC ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL peterjhassett©gmail.com