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HomeMy WebLinkAboutBLDG-19-01026 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " La CITY Yarmouth MA DATE 8/17/18 PERMIT it/9LP/r/9-00/0024 JOBSITE ADDRESS 11 ara OWNER ADDRESS 11 Christopher her Hall Way OWNER'S NAME 0-2171 Markus G py � � 2171 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[j EDUCATIONAL Li RESIDENTIAL[+ PRINT CLEARLY NEW:O RENOVATION:Li REPLACEMENT:LI PLANS SUBMITTED: YES© NOW APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER — — BOOSTER , li f 1: CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 4, ..h.'.. GENERATOR 1 GRILLE INFRARED HEATER a „�. LABORATORY COCKS MAKEUP AIR UNIT OVEN ,. _ ii POOL HEATER ROOM ISPACE HEATER 7 « h , fi ' ROOF TOP UNIT ..:. TEST 1 _ - UNIT HEATER _._ .. UNVENTED ROOM HEATER WATER HEATER OTHER — — — __ !I - 4 14 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 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT EI SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding thi appli tion are tn,,jggand a ur to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this applic on w be i�co ,c h Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /� ('/ PLUMBER-GASFITTER NAME[-William B.Holmes LICENSE#[45 2-M 1 SIGNATURE MP® MGF®+ JP 0 JGF[3 LPG!LI CORPORATION Eli# 043585106 PARTNERSHIP E 4#[ LLC 0#Mal COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS[381 Old Falmouth Road,Unit 13 1 CITY Marstons Mills STATE MA ZIP 02648 ITEL[508-428-0449 FAX CELL _ EMAIL ellen@rcaelectric.com # ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 Rod_ c(4) oxFEE: S PERMIT# /fC /ItRAL' /6//?/N PLAN REVIEW NOTES /%f /r