HomeMy WebLinkAboutBLDG-17-003710 MASSACHUSETTS Ut ;FO, APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�� Yarmouth 1/12/17
r�"I'�� CITY MA DATE PERMIT# '�7 10031 C®
JOBSITE ADDRESS 22 Edgewater Rd, S. Yarmouth OWNER'S NAME Steve Pezzella
GC)WNER ADDRESS 22 Edgewater Rd, S. Yarmouth MA 02664 TEL FAX N/A
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL IX
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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 - outside
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
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 [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 [II 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 accurat e be my knowle ge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance ' in rovi th
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Robert D. Fratus, Jr LICENSE# 11296 N UR
MP❑x MGF❑ JP❑ JGF❑ LPGI [.] CORPORATION ❑# PARTNERSHIP❑# LLC❑#
COMPANY NAME_ BC Plumbing & Heating ADDRESS PO Box 873
CITY Brewster STATE MA ZIP 02631 - TEL 508-896-9885
508-896-9130 508-958-1424 N/A clerical# 508-896-1878
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