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HomeMy WebLinkAboutBLDG-23-000066 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�" CITY YARMOUTH MA DATE July 06,2022 PERMIT# BLDG-23-000066 JOBSITE ADDRESS 20 FESSENDEN ST OWNERS NAME LAPOINT JOHN J G OWNER ADDRESS LAPOINT LILLIAN M 20 FESSENDEN STREET SOUTH YARMOUTH MA 02664-2919 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER 1 WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current Iiabilitr 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 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. 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME James Pazakis LICENSE# PL-15030-M SIGNATURE MP©MGF❑JP 0 JGF❑ LPG!0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JM PAZAKIS,INC. ADDRESS. 447 Old Chatham Road, CITY South Dennis STATE MA ZIP 02660 TEL 50831353677 FAX CELL` EMAIL S310N M3IA321 Mild #±I1A2i3d $:33d ❑ ❑ 111%13d 3H1 SV SAS NOIIVOIlddV SIHI oN seA S310N NO1133dSNI 1VNId A1N0 3Sfl W.1.03cISNI 6Od 39Vd SIHl S310N N01103dSNI SYJ HOfm