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HomeMy WebLinkAboutG-19-1801 Skt47i354 to S/4SC(V? ht00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK LCIN YARMOUTH MA DATE September 25, PERMIT# BLDG-19-001801 JOBSITE ADDRESS 6 SCOOP CIR OWNER'S NAME MURPHY CORAL A TR G OWNER ADDRESS MURPHY FAMILY RLTY TRUST 6 SCOOP CIR YARMOUTH PORT MA TEL 02675 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NOD 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 1 l \ GENERATOR b b/GRILLE V K, INFRARED HEATER • LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 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 Alex Braga LICENSE# 15668 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# • COMPANY NAME: I_ ADDRESS 110 Breeds Hill Rd, Unit 5, CITY (Hyannis _ STATE MA ZIP 02601 TEL • FAX CELL EMAIL Z— v# 2f?&70/ In IS g(7.1 2,4 931014 M31A3H NVId / #JJWa2d $:33d / / ❑ ❑lIW2i3d 3Hl SV S3A 3S NOIlVOIIddV SIE oN saA, S31ON NOI103dSNI 1VNId ,LINO 3Sf1210103dSNI 21Od 30Vd SRL S31ON NO1103dSNI SVO HOf1021