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HomeMy WebLinkAboutBLDG-19-002539 J13098 $50 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e.join=_- / C Sat= ri -2titi® CITY YARMOUTH MA DATE 10/19/18 PERMIT#/ ,o6-77��'1'S�i JOBSITE ADDRESS 198 WHITE ROCK RD OWNER'S NAME JOSEPH ZALESKI GOWNER ADDRESS SAME TEL 914-319-9340 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL a PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES NOD APPLIANCES 1 FLOORS-. 8SM1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER '- 4 BOOSTER _`� '�� .. _ i IIM .. : -I CONVERSION BURNER �., I • ; ll __ I _:_ II I COOK STOVE DIRECT VENT HEATER I ( 1 v .... r �__ ( f li 1.... DRYER +f I FIREPLACE FRYOLATOR • i FURNACE 1 -II ll GENERATOR i _ I GRILLE ,j �_ _ I I I INFRARED HEATER I n 1 . LABORATORY COCKS I MAKEUP AIR UNIT 1 I" ' '1 '' e J_, I . a OVEN ; r I ., . I I , POOL HEATER _ ROOM/SPACE HEATER ,- - .. I r II II ROOF TOP UNIT i I II — w i ii I p I TEST a e UNIT HEATER I I i' UNVENTED ROOM HEATER 4,-.4.4.4—,_ 1 • _ — _ 'I — n WATER HEATER OTHER W.: _._. . . .I II es, ],L ' ' �...,, f..r, L. , 1 11 i ..�4 1 1 �. 1. .. i I i 4; 1 1: a i1-1 ' 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 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 ar- - and a curate to the best� of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be' �/r•i.•ce '_all rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , - gar'Of PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 IF SIGNATURE MP Q MGF❑ JP❑ JGF p LPGI❑ CORPORATION a# 3969 PARTNERSHIP 0#[ I LLC❑# COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 JTEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea callmurphys.com // klaube©callmurphys.com / • Z— r/ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL,INSPECTION NOTES Yes No � / THIS APPLICATION SERVES AS THE PERMIT 0 0 /V /if ` FEE: $ PERMIT# /, PLAN REVIEW NOTES // (