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HomeMy WebLinkAboutBLDG-19-003374 J13148 $ 50.00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r wenn=r rl_@sy CITY YARMOUTH MA DATE 11128118 PERMIT#//LDer-)9-09547'r JOBSITE ADDRESS 291 OLD TOWNHOUSE RD OWNER'S NAME VOJIN VUJOSEVIC GOWNER ADDRESS 274 NORTH DENNIS RD YARMOUTHPORT,MA 02675 TEL 508-776-4137 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NOD APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -' Mt BOOSTER I f' Mr' S ' CONVERSION BURNERM _ _ COOK STOVE IMININNSIMISINEMIESIONIBMINECONINIM1140111111111111111111111111 DIRECT VENT HEATER DRYER FIREPLACE 1.010MilluileliONSIMISIMilimmitiallinloollimillieltliii FRYOLATOR FURNACE _ _ imailliilloplilismotilltaillili=laelligosgolsinglial GENERATOR IlliilleitimilliiIiiklililliiiiiitiNIIIIIIIIIIIISININCliitilli INFRARED HEATER antitialiiiiillaWilliMilillitIRIMIIIMSNWINCIMIIIII01 LABORATORY COCKS1.110•11•111111011.11.11.0.111.111iiiiiiiikilikaillistilli MAKEUP AIR UNIT n' ;M OVEN POOL HEATER ROOM/SPACE HEATER StililianiiiitiSSIONNISITIONSMSNINIS ROOF TOP UNIT TESTi _ ' ia UNIT HEATER ' UNVENTED ROOM HEATER _ i WATER HEATER OTHER 'n' einiatileit i - __ n IE a_ lean l_ 1111 Ellin INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 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:lam 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 ,�me a,d acc best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be I i pliam a • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `� 1 A sai PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 V. 17W-E MP D MGF❑ JP 0 JGF p LPGI❑ CORPORATION Q# 3969 PARTNERSHIP D# LLC❑# COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path w CITY South Yarmouth STATE 023.ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea callmurphys.com 1/ klaube©callmurphys.com LiefF ROUGII GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 fr/nfif C5&45 FEE: S PERMIT/I PLAN REVIEW NOTES L 4c /6Z,7/ 7/3