Loading...
HomeMy WebLinkAboutBLDG-19-001200 A"y, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 28, 2011 PERMIT# BLDG-19-001200 JOBSITE ADDRESS 7 DOE RD OWNERS NAME SLEIGHTER MIRIAM H G OWNER ADDRESS 7 DOE RD SOUTH YARMOUTH MA 02664-1810 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO© FIXTURES . FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES © NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF 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 General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Wiliam Holmes LICENSE# %4592 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: LCA Eletrical Contractors. Inc. ADDRESS 381 Old Falmouth Rd Unit 13, CITY Marstons Mills STATE[MA ZIP 02648 TEL 5084280449 FAX CELL EMAIL ellen(cDrcaetectric.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 4 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' Wild sC CITY Yarmouth MA DATE 8/23/18 PERMIT# J -it� t JOBSITE ADDRESS[7 Doe Road r OWNER'S NAME [Miriam Slei9hter GOWNER ADDRESS 17 Doe Road— — — 1 TEL[508-3983826 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:❑+ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 2 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER '' CONVERSION BURNER , _COOK STOVE DIRECT VENT HEATER ' DRYER FIREPLACE — FRYOLATOR FURNACE _. . ___ ___ _ .._ _ _- GENERATOR I GRILLE • - _ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN • , POOL HEATER , , ROOM I SPACE HEATER t I ' ROOF TOP UNIT TEST 1 - UNIT HEATER ' 1 : I UNVENTED ROOM HEATER WATER HEATER OTHER — — — — . .. , - r - —_ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [!.I NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑+ OTHER TYPE INDEMNITY Ll, 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appli tion e true an Apural tot best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application wi b i ac !h di nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME William B.Holmes LICENSE#14592-M GN TURE MP El MGFQ JP JGF❑ LPGI❑ CORPORATION[+_J# 043585106 1 PARTNERSHIPLi#L LLC D#[---1 COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13 CITY Marstons Mills STATE MA ZIP 02648 JTEL 508-428-0449 FAXII CELLI _EMAIL ellen@rcaelectric.comI ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No See THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /J✓�-���'I// An .Se • a' FEE: $ PERMIT# /1` 1C /�'A1 �{/y PLAN REVIEW NOTES v /� v ammita 1