HomeMy WebLinkAboutBLDG-18-006879 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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:1';Itl-g..? CITY tarmouth I MA DATE 5/30/18 PERMIT#fra VI-eV"
JOBSITE ADDRESS'72 Captain Besse Road OWNER'S NAME Marie Rainville
GOWNER ADDRESS 1 72 Captain Besse Road I TEL 413-244-5040 1FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL Li RESIDENTIAL L✓
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CLEARLY NEW:Q RENOVATION:D REPLACEMENT:U PLANS SUBMITTED: YES 0 NOQ+
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER r
BOOSTER ! • i ! iI
CONVERSION BURNER - 'I I ii I
COOK STOVE _
DIRECT VENT HEATER
DRYER p '
FIREPLACE
FRYOLATOR 1 ! '
.- --- - -
FURNACE I ! I u
GENERATOR 1
GRILLE
INFRARED HEATER ',II.
LABORATORY COCKS
MAKEUP AIR UNITi
OVEN , . ,
POOL HEATER
ROOM I SPACE HEATERf
ROOF TOP UNITI ! i I
TEST 1 - --- _ _- _ _ _ I
UNIT HEATER . u I u
UNVENTED ROOM HEATER
WATER HEATER
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OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO Q it
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I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ElOTHER TYPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE WAIVE . afn aw that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts giietaItawl;aStha tature on tfi3'pefmIt application waives this requirement.
a CHECK ONE ONLY: OWNER Q AGENT Q
SIGNATURE •F 4 4- OR •. NT _ _
I hereby certify that al cLf jh f1(@fellS.6nr�'i0fpmla jen 'ta or entered regarding this ap c do are e floc t he best of my knowledge
and that all plumdirt§ ork and Installations pew d under the permit Issued for this application e n jo Ira `r d.wi111 .ire
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. $"'
PLUMBER-GASFITTER NAME Wiliam B.Holmes LICENSE# 4592-M SIGNATURE
MP Q MGF Q+ JP Q JGF® LPG'® CORPORATION.#'04358510 6 'PARTNERSHIP D1# LLC D#
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COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS'381 Old Falmouth Road,Unit 13 s
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CITY Marstons Mills STATE MA ZIP 02648 TEL!508428-0449 J
FAX CELL EMAIL bill@rcae'ectric.com _ _
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Pell
a /JYes No
!/�F�✓S U THIS APPLICATION SERVES AS THE PERMIT 0 0 Q
/A x/ FEE: $ PERMIT# !/ �2' Q.
PLAN REVIEW NOTES I
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