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Home My WebLink AboutBLDG-19-002125 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =_ate= -44L CITY West Yarmouth MA DATE 10/4/18 PERMIT#1DbT n-Oa 2 r ' 0JOBSRE ADDRESS 2dl Hedge Row (OWNER'S NAME Carr GOWNER ADDRESS same TEL 508-665.7798 JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOQ APPLIANCES 1 FLOORS-, ' BSM 1 2 3 4 5 6 7 8 I 9 10 11 12 13 14 BOILER BOOSTER —11- moI l CONVERSION BURNER CI I—° tl t___,i—J— COOK STOVE DIRECT VENT HEATER — —II— 1 1 — 1 —t—i— 11 DRYER FIREPLACE FRYOLATOR i 1— — FURNACE 1 y J—I— — GENERATOR GRILLE — - INFRARED HEATER L..-___ _ _ _ — k_ LABORATORY COCKS _ _ _ _ MAKEUP AIR UNIT OVEN — — I—,— POOLHEATER - - _ _�_ ROOM/SPACE HEATER _' ROOF TOP UNIT I___,._ - -p — TEST �_,y�_ _, UNIT HEATER —I— — —'1 _'_I 1 —>1�-- UNVENTED ROOM HEATER li 1 I ' WATER HEATER OTHER �_, —I f 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 0 OTHER TYPE INDEMNITY ❑ 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 ❑ 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. ?with Rodd PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP El MGF❑ JP❑ JGF 0 LPG!❑ CORPORATION Q# 1762-C PARTNERSHIP 0# LLC❑# COMPANY NAME: Rusts Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL EMAIL mburke©rustysinc.com 928415 /4 i'/,t/rt