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HomeMy WebLinkAboutBLDG-19-002424 Unit 602 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7c _f CITY West Yarmouth MA DATE 10/23/18 PERMIT#/ S'l9W7 9 JOBSITE ADDRESS 345 Camp Street,Unit#602 1 OWNER'S NAME Charles White Management GOWNER ADDRESS 330 Commonwealth Ave,Boston TEII 617.267.1283 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Di EDUCATIONAL ❑ RESIDENTIAL 0 PRINT . CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES NO❑+ APPLIANCES T FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER I 1 I I—k I � ' CONVERSION BURNER i_1 r 1 COOK STOVE DIRECT VENT HEATER f i I I • k DRYER m f I, - I �-- FIREPLACE FRYOLATOR -----71'- f 11 h N 9 —N— FURNACE t I n —I I rl GENERATOR GRILLE 4 I I 1 I— I —N-N-= INFRARED HEATER — LABORATORY COCKS MAKEUP AIR UNIT OVEN -- I 1 — POOL HEATER - - - -0 -E-Hai 13- ROOM(SPACE HEATER —I`-1 ,I p I 11 - -� 1— v— ROOF TOP UNIT 1`-' I 1 fl h 1-1i- 141 LOI - 1 41 TEST - , - ,- - - - - - UNIT HEATER n, G OF ART e r v— UNVENTED ROOM HEATER i _ -- WATER HEATER — W OTHER Gas Test 1 II I y 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 Q 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 Tirrifi 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�alllPPPertinent provision rovisio of the ch Massausetts State Plumbing Code and Chapter 142 of the General Laws. X777Roc t4 e PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP El MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION 0# 1762-C PARTNERSHIP 0# LLC❑# COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive 1 CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL EMAIL mburke©rustysinc.com In 928769 C\C� ., ?_R/051-1a4--9 c6c o5 7 /$//gLe /amr//r 7