HomeMy WebLinkAboutBLDG-19-001794 1: ,. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
. _91 ) CITY Yarmouth MA DATE 9/20/18 , PERMIT# 1_ /`-
JOBSITE ADDRESS 88 Pond Street OWNER'S NAME 88 Pond Street
GOWNER ADDRESS 1 88 Pond Street 3 TEL 484-406-3847 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑+ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER — —
BOOSTER I I1 U
CONVERSION BURNER I 1; 1 _ i el ... I _
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE -- , — —
GENERATOR '1 I
GRILLE
INFRARED HEATER
LABORATORY COCKS . .
MAKEUP AIR UNIT i'; .. '....,, I ._. . I -. ,
OVEN
POOL HEATER
ROOM ISPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER ,
WATER HEATER
OTHER I \--Ai 1 — — —._
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [LI NO LI
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY DI OTHER TYPE INDEMNITY J 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 applic i trund ra th best of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application wil a ' nt provision of the I
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. may'
PLUMBER-GASFITTER NAME William B.Holmes LICENSE#[4592-M SIGNATURE
MP❑ MGF Li JP❑ JGF❑ LPGI U CORPORATION 0# 043585106 PARTNERSHIP[]#' LLC❑#
COMPANY NAME: RCA Electrical Contractors Inc. 'ADDRESS L381 Old Falmouth Road,Unit 13 1
CITY Marstons Mills STATE` MA 'ZIP 02648 TEL 508-028-0449
FAX CELL JEMAILf ellen@rcaelectric.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
No
SNOW/ iii /' THIS APPLICATION SERVES AS THE PERMIT Yes ID 0
FEE: $ PERMIT# it1, /� /, /' ' j
K j 'Ip/��►�[ / PLAN REVIEW NOTES 1 Off
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