HomeMy WebLinkAboutBLDG-19-002948 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY Yarmouth Port MA DATE 11/8/2018 PERMIT#/ � /Q DDa
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JOBSITE ADDRESS 168 White Rock Road OWNER'S NAME Chris Hughes
GOWNER ADDRESS Same TEL (FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIALD
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NOD
APPLIANCES 7 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1 i i
BOOSTER : _ — I
CONVERSION BURNER _ i
COOK STOVE
DIRECT DRYER VENT HEATER I 1 ,I
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR 'r---j Irt Pi°
GRILLE 1 _, IOR
INFRARED HEATER
LABORATORY COCKS 31;lisigi„Re
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MAKEUP AIR UNIT
OVEN . .1 . 1 _ _, E r
POOL HEATER
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ROOM!SPACE HEATER
ROOF TOP UNIT q
TEST — 13 L __�
UNIT HEATER '
UNVENTED ROOM HEATER _ _ um_ ' pg= !1FN i
WATER HEATER Y_ __
OTHER
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ❑NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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
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 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 Tygue S Reed LICENSE# 15200 (f SIGNATURE
MP Q MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC D# 4047C
COMPANY NAME: Coastal Mechanical ADDRESS 299 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747
FAX 508-760-5800 CELL 508-246-9959 EMAIL lisaatcoastalphc.com
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