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HomeMy WebLinkAboutBLDP&G-20-002868 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY Yarmouth MA DATE 11/18/2019 PERMIT#,Ae4/9/ O -C2VS-6� JOBSITE ADDRESS 163 Webbers Path OWNER'S NAME Charles D.Provonche,Sheila Murphy POWNER ADDRESS 163 Webbers Path TEL 05 8 398-0408 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL -] EDUCATIONAL 7...1 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES-1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL _ SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER 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 TYPE OF INDEMNITY I— 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 c ian711nea o si the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Peter J.Hassett LICENSE# L11682 I SIGNATURE MP JP I CORPORATION ' # 3506 PARTNERSHIP # LLC # COMPANY NAME Hassett Plumbing and Heating, Inc. ADDRESS 8 Skipper Lane CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL peterjhassett@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IL!, CITY Yarmouth MA DATE 11/18/2019 PERMIT# P old-o0 ®fig JOBSITE ADDRESS 163 Webbers Path OWNER'S NAME Charles D.Provonche,Sheila Murphy GOWNER ADDRESS Charles D.Provonche,Sheila Murphy TEL 508-1401414133..3 g ;‘)FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 7 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 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 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I 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`ompli with I� n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Peter J.Hassett LICENSE# 11682 SIGNATURE MP MGF JP JGF LPG! CORPORATION # 3506 PARTNERSHIP # LLC # COMPANY NAME: Hassett Plumbing and Heating Inc. ADDRESS 8 Skipper Lane CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL petedhassett@gmail.com G-24- FAO'"' roa m