HomeMy WebLinkAboutBLDG-19-003908 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
MAP PARCEL MA DATE 12/28/18 PERMIT# r3i-P1,-7/s-ov.gd i
JOBSITE ADDRESS 42 Scallop Rd.Yarmo uth,Ma. OWNER'S NAME John Spillane
GOWNER ADDRESS Same TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: ' REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES 1 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 x
MAKEUP AIR UNIT /�/�� if°(f
OVEN '
POOLPOOL 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 compliance ' all rtinent jmil on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 9/
PLUMBER-GASFITTER NAME Michael Pereira LICENSE# 10600 GNATU
MP ' MGF ' JP JGF LPGI CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:M.D.Pereira Pig.&Htg. ADDRESS 27 Lawrence Ln.
CITY Centerville STATE Ma ZIP 02632 TEL 508-790-2686
FAX CELL 5-8-776-5846 EMAIL usermvp8181@aol.com
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