BLDG-18-006881 err prr4«cc
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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AGI_ CITY Yarmouth MA DATE 5/30/18 PERMIT#/iiD6/7"{aaC$
JOBSITE ADDRESS 21 Windjammer Lane OWNER'S NAME I Artemis Boyjian
GOWNER ADDRESS 8 Green meadow Bloomfield,CT 06002 TE 860-997-0087 FAX f t
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALD
PRINT
CLEARLY NEW:❑+ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NOD
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I♦IIIIIIIIIIIIIIIII_IIIII___IIIIIII_II___
BOOSTER 1111111111111111111111111111111111111111111111111 '_____'_
CONVERSION BURNER _11111111111_1111___' _____11111
COOK STOVE ___ 1111111__________
DIRECT VENT HEATER _______________
DRYER 1111111//111111111111111111111111111111 1111111111111111111111111111111111111I
FIREPLACE 1101111111111111111__11111_ _____
FRYOLATOR ___111111'_'__________
FURNACE1111111_______MIIII____,
GENERATOR 1 111111 __________111111__
GRILLE 11111_1111111111______111111__11111_
INFRARED HEATER _ 111111111111__111111111111111___111111111111___
LABORATORY COCKS ___r11111______1111111111111- `
MAKEUP AIR UNIT ______________
OVEN ________INIIII_I__I__I_ -
POOL HEATER i__IIIII__IIIIIIIIII_IIIII __ _INNI
ROOM/SPACE HEATER ________._-_____
ROOF TOP UNIT ___NMI, ______'_'S i_,
TEST 1111111111111111111111111111111111111111011111111111111111111111111111111111111111111111111111
UNIT HEATER EMI®®111111111_®111111111111I_I__SEMIS
UNVENTED ROOM HEATER SIMMS 1111111111111111.111111111111111111111111111113111111111111111111111111
WATER HEATER ____®__________
OTHER __®_I__ _I�___®____
all NE ' _________
___1111111111111111111111111111111111111111111111111
_IIIII_NINNINIS_IIISMIU_I__ I_I_
INSURANCE COVERAGE ..
I have a current liability insurance policyor its substantial equivalent which meets the requirements of MGL.Ch.142 YES D NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑+ OTHER TYPE INDEMNITY Li BOND ❑
OWNER'S INSU NCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
crMassachus eneraaI)a✓vg�t nnd1that signature on this permit application waives this requirement
"'- • t- ��--- CHECK ONE ONLY: OWNER ❑ AGENT ID
SIGNATURE OFOWtiERORAGENT
I hereby certify that all of the details and information I have submitted or entered regarding this a ifif n -r, - f'•a it m.the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this applicatio . • .I. w 'I.' e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - r
PLUMBER-GASFITTER NAMEWilliam B.Holmes _----I LICENSE#[4592-M - SIGNATURE
MP❑ MGF a JP❑ JGF❑ LPGI❑ CORPORATION❑' # 043585106 PARTNERSHIP 0#1 I LLC 0#{ 1
COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS[381 Old Falmouth Road,Unit 13 1
CITY Marstons Mills STATE MA ZIP 02648 TEL 508-428-0449
FAX CELL EMAIL bill @rcaelectric.com I
In
•
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0 '
eb# FEE: $ `. PERMIT# rk' 7
PLAN REVIEW NOTES