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HomeMy WebLinkAboutG-19-2881 J13125 $50 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -=1 ;" CITY YARMOUTH MA DATE 11/2/18 PERMIT# t A4-N--00,01.%31 JOBSITE ADDRESS 8 CAPTAIN 3/4(..,..g4 I OWNER'S NAME SUSAN&WILLIAM SULLIVAN GOWNER ADDRESS 64 LYNDON RD PROVIDENCE RI 02905 TEL 617-834-6184 FAX TYPE OR OCCUPANCY TYPE COMMERCIALE] EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES© NO❑ APPLIANCES 7 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 i I . II ; BOOSTER CONVERSION BURNER ' s�:r ., COOK STOVE DIRECT VENT HEATER I DRYER FIREPLACE FRYOLATOR I ., 'i 1 FURNACE a. 1 11 I GENERATOR GRILLE i 1 1I INFRARED HEATER • — • - .,- - .4.. .. - _, . ,,, _,w s. . , , .,. IIS .. ` LABORATORY COCKS • MAKEUP AIR UNIT 1 t1 II •. ,s- .'k. , is_. 1r-- OVEN •••L HEATER ROOM I SPACE HEATER r : .1 ROOF TOP UNIT : .. • y Ir I.e TEST , UNIT HEATER a_.e...,. •I-. ' i I .m,C ' .a UNVENTED ROOM HEATER 4 --- r a 1 1I - WATER HEATER , OTHER I !_� ..�_'. � �1 .i _� .. ,ice_ .. .,.. -wL.. �e'=! ii ! , "!. 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 Q OTHER TYPE INDEMNITY Q BOND El 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 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this applicat lili t e and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will i liq with all of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J\ PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 SIGNATURE MP C] MGF❑ JP U JGF❑ LPGI 0 CORPORATION 0# 3969 PARTNERSHIP Oa LLC®# COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path - CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 • FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com 1/ klaube@callmurphys.com ( y.g//