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HomeMy WebLinkAboutBLDG-18-007105 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _'s'w. C `:MVI , CITY Yarmouth MA DATE 6/11/18 PERMIT# i b-fi-° dna- JOBSITE ADDRESS 3 Nautical Lane ,OWNER'S NAME Daniel Ewing GOWNER ADDRESS 3 Nautical Lane I TEL 781-801-2311 {FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:[J PLANS SUBMITTED: YES© NO ' APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5- 6 7 I 8 9 10 11 12 13 14 BOILER v a BOOSTER I CONVERSION BURNER ( COOK STOVE _ __ , DIRECT VENT HEATER r . DRYER i I I FIREPLACE - .. --_ . .- ., . .- .. FRYOLATOR FURNACE .L FURNACE GENERATOR 14v GRILLE __. _ . INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT r fl . OVEN I - POOL HEATER - _ -I M • ROOM /SPACE HEATER M t ROOF TOP UNIT — TEST ® 1 ' UNIT HEATER _ UNVENTED ROOM HEATER 1 J _ WATER HEATER 1 - I OTHER �.. ._. i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0 tpl I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 BOND 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. , CHECK ONE ONLY: OWNER El AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this appl ation re true a u to a best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application I i co ian ith e ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME William B.Holmes LICENSE#14592-M 1 SIGNATURE MP 0 MGF I JP❑ JGF 0 LPGI® CORPORATION ILO 043585106 PARTNERSHIP EA J LLC 0# . COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13 I :- CITY Marstons Mills STATE MA ZIP 02648 TEL 508-428-0449 FAX CELL EMAILI billy@rcaelectdc.com - MM , ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No f th//_ 6?#13 / / THIS APPLICATION SERVES AS THE PERMIT ❑ 0 15-5/ rf 6 z"L/ re /r FEE: $ PERMIT# /1-.-4364. OR PLAN REVIEW NOTES 7 /6A-- Nyb ni 0,5 gc ziyit *br' • •