HomeMy WebLinkAboutBLDG-18-002387 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
T"�1,I CITY Yarmouth MA DATE PERMIT# /X-04,/f-0?-15i>
JOBSITE ADDRESS 17 Trowbridge Path OWNER'S NAME Dominic&Wendy Mengella_ 1
GOWNER ADDRESS Dominic&Wendy Mengella TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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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 1_j
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 I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
.,rd ..., .x x-il�..36,. ,,�„g.. , ��,_,. 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 .•• accurate to th- •-st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in corn• .• y/ '-"�ent� •__of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / ��
PLUMBER-GASFITTER NAME Peter J. Hassett LICENSE# 11682 ' SIGNATU'E
MP - MGF JP JGF LPGI 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