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HomeMy WebLinkAboutBLDG-23-002605 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY [YARMOUTH MA DATE November 10,202: PERMIT# BLDG-23-002605 JOBSITE ADDRESS 16 JOYCE ST OWNER'S NAME PUTNAM EUNICE P TR G OWNER ADDRESS THE EUNICE P PUTNAM LVG TRUST 16 JOYCE ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 . BOILER 1 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 1 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❑ 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 -egarding this application are true and accurate to the best of my knowledge and that all plumping 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 William Pizzano LICENSE# 13748 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑ # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: E'ILLIAM E PIZZANO ADDRESS. 51 Maple, CITY Rockland STATE MA ZIP 02370 TEL FAX ]CELL EMAIL will.pizzano(a gmail.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 '"It•HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK \_G 7'11CITY: 161,hT( ! MA. DATE II 1 G�V1:'. PERMIT# Z 3 l (c' °)— V ())OBS AD •=- • j(-7 J l )/` Ci E �.J I OWNER'S NAME: a-tv OEC.8141./.\.n 3U N C oRE TEL: FAX: E-flR UUI:UPANCYTYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO ra APPLIANCES" FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER l , BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER ' LDRYER . FIREPLACE _ FRYOLATOR FURNACE GENERATOR ' GRILLE Vl INFRARED HEATER j� LABORATORY CCCK MAKEUP AIR UNIT ' OVEN , '' POOL HEATER ROOM 1 SPACE HEATER -J ROOF TOP UNIT ' TEST X _ Z UNIT HEATER I.1 UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current Mrility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES f NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND 0 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 I� AGENT 0 SIGNATURE OF OWNER OR AGENT 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 rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTERNAME: �LLIAi'\ O1LzZ4rvie LICENSE# 13'74 SIGNATURE COMPANY NAME: IALTIL- fl( 0Z.7.14Ak) ADDRESS: _5( 11111 i CITY: EN_L _IJV t) STATE: [I if i ZIP: OZ 3`7 L' FAX: � I TEL: 1 J 1-?G'l-//�� (. ( CELL: EMAIL: 1,011 I Pf ZZ R I it ' . G Rift'I(r (.06/\ MASTER JOURNEYMAN 0 LP INSTALLER❑ CORPORATION❑## PARTNERSHIP❑# LLC❑# c Sri 4.,L ADikee-.SS : • r;t ; • • • • 1. � is ._i r':.. .. . .. ,