HomeMy WebLinkAboutBLDG-18-006678 _ _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
AI=(_ CITY Yarmouth MA DATE 5/21/18 PERMIT#ne-11P-120GO ;
JOBSITE ADDRESS 63 Mayflower Terrace OWNERS NAME Jennifer Crimaldi
GOWNER ADDRESS 63 Mayflower Terrace a TEL 508-685-4867 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIALa
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CLEARLY NEW:❑+ RENOVATION:CI REPLACEMENT:DI PLANS SUBMITTED: YES E] NOD
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER 9
CONVERSION BURNER r c i ', 1 i' -_ _ I ._.
COOK STOVE
GENERATORDIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
: 11+11111111 111
1
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT f — 'i
;i i .,'. '
II
OVEN i I l
POOL HEATER
ROOM/SPACE HEATER 1! I
ROOF TOP UNIT ;— , - --,1 -- -..— ---„ --- ,I—
TEST 1
UNIT HEATER -- __-- i- — . -- — t
INVENTED ROOM HEATER
WATER HEATER • ---
OTHER I :, . 1:—
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INSURANCE COVERAGE
I have a current liability insurance policy or 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 e
LIABILITY INSURANCE POLICY Ej OTHER TYPE 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 ,al Laws,1 an. that my signature on this permit application waives this requirement
SIGNATURE OF OWNS- CHECK ONE ONLY: OWNER El AGENT El
I hereby certify that all of the details and information I have submitted or entered regarding this application a ru and o t es f my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in rye�i(y eft' ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' ��/
PLUMBER-GASFITTER NAME William B.Holmes LICENSE# 4592-M SIGNATURE
MP❑ MGF❑+ JP 0 JGF❑ LPG/❑ CORPORATION D# 043585106 PARTNERSHIP❑# LLC❑#
COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13
CITY Marstons Mills STATE MA ZIP 02648 TEL 508-428-0449 3
FAX CELL EMAIL billy@rcaelectric.com I
M9-
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ElGn -t ❑
' 1 FEE: $ PERMIT# �/>l
'� PLAN REVIEW NOTES !/Y)/�
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