Loading...
HomeMy WebLinkAboutBLDG-21-005950 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R —( BLDG-21-005950 CITY YARMOUTH MA DATE April 14,2021 PERMIT# ill JOBSITE ADDRESS 8 SKIPPER LN OWNERS NAME HASSETT PETER J G OWNER ADDRESS 8 SKIPPER LN YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 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 1 FIREPLACE _ FRYOLATOR FURNACE GENERATOR _ 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 El 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 0 JP❑ JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PETER J HASSETT ADDRESS. 8 Skipper Lane,Hassett Plumbing&Heating Inc. CITY Yarmouth Port STATE MA ZIP 02675 TEL FAX CELL EMAIL peterjhassettaRomail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r. 7 CITY Yarmouth ryJ MA DATE`411021 << PERMIT # �L ��' Zl—C7o Sal V2 f d JOBSITE ADDRESS Skipper Lane OWNER'S NAME Peter Hassett OWNER ADDRESS Peter Hassett TEL508 237c2175 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES l 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 DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR I GRILLE INFRARED HEATER LABORATORY COCKS A_ MAKEUP AIR UNIT OVEN :. POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST 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 NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER 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 under the permit issued for this application will be in complian th a 'j .vision``• Massachusetts State Plumbing Code and Chapter 142 of the General Laws. —_ PLUMBER-GASFITTER NAME Litter J. Hassett LICENSE # 11682 S NATURE ry-_''Mrt9-/ .via'•••--1.'_.. '.. MP ' MGF JP JGF LPGI CORPORATION # 3506 PARTNERSHIP D#j LLC # — — COMPANY NAME:Hassett Plumbing and Heating Inc. ADDRESS L88Skipper Lane CITY I Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL peter'hassett@gmail.com