HomeMy WebLinkAboutBLDG-19-000244 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
iN
`.4-.4 _3, CITY Yarmouth MA DATE 17/5/18 I PERMIT# 4tWb'to/7"-$° /
JOBSITE ADDRESS 91 Pleasant Street OWNER'S NAME Francois Buisson '
GOWNER ADDRESS 91 PLeasant Street TE 508-394-0904 FAX !
P TYEOR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL C] RESIDENTIAL
NT
CLEARLY NEW:Q RENOVATION:[ REPLACEMENT: PLANS SUBMITTED: YES® NOE]
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 r 9 10 11 12 r 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE ,._ ,
i_
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR 1 + k
GRILLE
INFRARED HEATER y
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
9 j I
POOL HEATER 1
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST 1
a �
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
i t I
,
,
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 [
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 779--/op_ duo
LIABILITY INSURANCE POLICY �I OTHER TYPE INDEMNITY ® BOND 0 9�77�j/
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.
r� 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 applica r d at he est of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will rueall provision 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 JGF[ LPGI0 CORPORATION Litt 043585106 PARTNERSHIP o#; LLC 3#
COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 381 Old Falmouth Road,Unit 13
CITY Marstons Mills } STATE MA 3ZIP102648 , JTELI508-028-0449
FAX CELL 3EMAIL ellen@rcaelectric.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No / p �y,�
/i2b/1 449 �4 THIS APPLICATION SERVES AS THE PERMIT ❑ 9 /� `/ !�B"'`.7 0,
�/\(Y Li& /D/O /i FEE: S PERMIT# //LIT' /dA�/�
PLAN REVIEW NOTES