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HomeMy WebLinkAboutBLDG-18-006880 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Nikr.I CITY Yarmouth -- I MA DATE 5130/18 PERMIT#&p6'f rad l8'e0 ' JOBSITE ADDRESS 39 Belle of the West Rd OWNER'S NAME Ross Coppelman 1 GOWNER ADDRESS 39 Belle of the West Rd I TE 508-362-0886 FAX J E. TYPE OR OCCUPANCY TYPE COMMERCIAL0 EDUCATIONAL D. RESIDENTIAL El PRINT CLEARLY NEW:Q RENOVATION:© REPLACEMENT:U PLANS SUBMITTED: YES NOD APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 . - -. BOILER ! BOOSTER CONVERSION BURNER _ COOK STOVE i i DIRECT VENT HEATER t t ff DRYER -.. . ._. FIREPLACE m b FRYOLATOR R f a FURNACE ! ,� GENERATOR 1 r I GRILLE - - ' INFRARED HEATER LABORATORY COCKS ' ' MAKEUP AIR UNIT OVEN T4 POOL HEATER _ _ ROOM/SPACE HEATER t-- ROOF ROOF TOP UNIT r - - . . _ _ _ _ . . TEST 1 .— — - -- -- UNIT HEATER 1 _ UNVENTED ROOM HEATER ____' WATER HEATER OTHER — — — — ,- - , - - - I t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'SiDIWRANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachose Gen a� ;end t my signature on this permit application waives this requirement lit rr� C.. CHECK ONE ONLY: OWNER p AGENT ❑ SIGNATURE OF OIMER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this pli on ad rat to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicati II e irMI ce e ' t rovisio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4. PLUMBER-GASFITTER NAME William B.Holmes LICENSE#[4592-M1 SIGNATURE MP❑ MGF❑+ JP JGF❑ LPGI❑ CORPORATION Q# 043585106 PARTNERSHIP D# LLC❑#11111.1111 ' COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13 CITY Marstons Mills STATE MA ZIP 02648 TEL 508-428-0449 1 FAX CELL - EMAIL bill grcaelectric.com --- I . 'a I ' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No faTHIS APPLICATION SERVES AS THE PERMIT 0 0 /AP— �A FEE: $ PERMIT Pi/ V " ‘411 4 fiL�1f _ . _ i d' � /i////tel PLAN REVIEW NOTES • • F. �__