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HomeMy WebLinkAboutBLDG-19-001956 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK c Trn=;" ®` f_s e' CITY YARMOUTH MA DATE 9126118 PERMIT# /1_,9& �9`��`4'' • JOBSITE ADDRESS 15 ROSE ROAD OWNER'S NAME CHRIS LEGRE GOWNER ADDRESS SAME TEL (774)353-7113 $FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 67 8 9 10 11 12 13 14 BOILER i +w . BOOSTER II �C^ n CONVERSION BURNER � I I t COOK STOVE i4 DIRECT VENT HEATER I i �;— '' I .... I.-. .,,5(� R DRYE �.0 I FIREPLACE . . i` ,, FURNACEFRYOLATOR eta a t I ri `.r w �e �r_.�-t $- _ ��x 3d r. e � 11�.4 ...,. .... _ ... _ .._. _ i. GENERATOR GRILLE I i ' ^ . I1` . 71( `C INFRARED HEATER LABORATORY COCKS 'r MAKEUP AIR UNIT f ( �I I' OVEN l '' -.. I I l', POOL HEATER1' ROOM I SPACE HEATER Ir l q �_ 'I it II r 4 ROOF TOP UNIT y, . r - TEST UNIT HEATER I I I UNVENTED ROOM HEATER '_ i, I- 1 WATER HEATER — _ OTHERI ._. . . I I I ( 9I i 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 ci OTHER TYPE INDEMNITY p 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 Q AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application ar> - :nd ccurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in • • nc: 'th a edine rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 SIGNATURE MP ED MGF Q JP❑ JGF❑ LPG'❑ CORPORATION Q# 3969 PARTNERSHIP 0# LLC❑# COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL csheaecallmurphys.com 11 klaube©callmurphys.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT I{ C 60' PLAN REVIEW NOTESU AJC ger