HomeMy WebLinkAboutBLDG-15-002456 1( 1,31 ‘a
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
r(_ t CITY Yarmouth MA DATE Oct.29,2014 PERMIT# /.314)47—.16--0002t/ •
( 1 JOBSITE ADDRESS 210 Kates Path OWNERS NAME Mr.Kelly
GOWNER ADDRESS TEL !FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIALD
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑
APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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CONVERSION BURNER ' F .
COOK STOVE111111111111111111.111111111111111.111111111111111111111111111111111111
DIRECT VENT HEATER1111001S11111111.1S111111119111111111101111111111111111011.1111101111111111(
DRYER 111111111111111111.101111111111111.111a0111111111111111SSIS
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FIREPLACE 111111111111111111111.1111111111111011111110011111.11.1111.111111011111110111.111
FRYOLATOR IM
FURNACE ,
GENERATOR .1111111111101111111
GRILLE ... _...
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INFRARED HEATERSIIIIM111111111-110111111/1111111flailliallitIMI
LABORATORY 11111111111S11111111111111111.111/N11111111111111S1111111111011115
MAKEUP AIR UNIT .
OVEN S INX1 'S
POOL HEATER 1111.1111111.111111111011111111111111111 _ _
ROOM ISPACE HEATER
ROOF TOP UNIT ' S1111111IIS
TEST 1111111111111111111111111111111111111111111111111111111111111011111111111111111101111111111131.
UNI EATER-----.—--
UN ENTED ROOM HEATER'= GI m5f S 1111k
11M101111111111111111111111111 i 11/11111111114111111- 111111111-— 111S- S11.11111111111111. 11111111111111111111.111.111111111
ill E3UILU:i1.340 .:r tai 1111411MalaltillalliMalliniantallitaillM
mil/ alli INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO El
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 ❑
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 William Heath LICENSE# 12021 1 SIGNATURE
MP Q MGF® JP❑ JGF 0 LPG'❑ CORPORATION D# 3487C PARTNERSHIP❑# LLC❑#
COMPANY NAME: Murphys ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660
FAX 508-760-1670 CELL EMAIL Itetrault@callmurphys.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT It
PLAN REVIEW NOTES
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