HomeMy WebLinkAboutBLDG-19-001709 MASSACHUSETTS�yUNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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';W(_ CITY Yarmouth `6�0 MA DATE 9/17/18 PERMIT# --/9'0 /7a?
JOBSITE ADDRESS(Pheasant Cove Circle OWNER'S NAME Jeff Senecal
GOWNER ADDRESS '8/Pheasant Cove Circle
W TEL 508-662-2600 'FAX
TYPEOR OCCUPANCY TYPE COMMERCIAL[PRINT .,] EDUCATIONAL [j RESIDENTIAL[±]
CLEARLY NEW:Q RENOVATION:[ REPLACEMENT:U PLANS SUBMITTED: YES 0 NOD
APPLIANCES 1 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 i - i
DRYER
FIREPLACE
FRYOLATOR
FURNACE
' GENERATOR t
GRILLE
INFRARED HEATER f
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER ,
ROOF TOP UNIT
TEST 1
UNIT HEATER
UN'VENTED ROOM HEATER .--___ _. - _ ®_
WATER HEATER
OTHER -- —
, . i
INSURANCE COVERAGE -
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES (_+]NO Q
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [] 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 Q AGENT Q
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted or entered regarding this ap icati are true an accurate t the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application i n co plia 1 P inent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME William B.Holmes 1 LICENSE#F592- j SI NATURE
MP Q MGF 0 JP Q JGF Q LPGI[—I CORPORATION 0#x.043565106 J PARTNERSHIP[M #L J LLC D#[ 1
COMPANY NAME: RCA Electrical Contractors Inc. _j ADDRESS[381 Old Falmouth Road,Unit 13 J
CITY Marstons Mills _ J STATE I MA jZIP 02648 ITEL1508-428-0449
FAX CELL,-_ EMAIL ellen@rcaelectric.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
/ THIS APPLICATION SERVES AS THE PERMIT 0 0
?(W `� FEE: S PERMIT# G iC_{^ // &7/?
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(///,,A PLAN REVIEW NOTES