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Home My WebLink AboutG-19-3529 HILLIS $50 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -saw CITY YARMOUTH MA DATE 11/28/18 PERMIT##--/ /7 )10 • JOBSITE ADDRESS 15 TOURAINE WAY OWNER'S NAME MARK HILLIS GOWNER ADDRESS SAME TEL 508-377-2055 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:la PLANS SUBMITTED: YES U NOD APPLIANCES 1 .FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ ' BOOSTER _ CONVERSION BURNER COOK STOVE1111111111111C; , DIRECT VENT HEATER 1111111MMISMISWISWIlltaaltallitS DRYER _ a FIREPLACE ar 1 al 1 1 : 1 1 1 1 FRYOLATOR FURNACE 11111111101011111110101•11111110111011111MMOKSIOUNESIONNS GENERATOR _ S. GRILLE �' . 1111111111II' 1 INFRARED HEATER 11. 111001 1 1 M LABORATORY COCKS - ! MAKEUP AIR UNIT _. _ OVEN ........... POOL HEATERi_ ROOM/SPACE HEATER ' ROOF TOP UNIT IS Ilinnalallialle.1111.011101ainillitia TEST IMIIIIIIIIINIIIIMPIINIINIIMIIPINIIIIIIIIIIIIIIOIIMIEIIIIIIIIIMIIIIMIOIIIUIIIIIGONIE UNIT HEATER _ _ UNVENTED ROOM HEATER 1111 WATER HEATER OTHER WIIIIIIIMIIMMILIIIIIIIMillitaSillailtiMISIS 1011111111111111111111110111111/111141111111111111111111.1111111/1010111111.11011111101.111011.11111111111 111111111111111111111111111111111111111111111aallitIMINIIIMaletaillS 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 0 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 0 AGENT D SIGNATURE OF OWNER OR AGENT A I hereby certify that all of the details and information I have submitted or entered regarding this applicati• and a - he best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b- lianc- ith all Pe.' rnt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 J - SIGNATURE MP MGFQ JP0 JGF© LPGID CORPORATION EP/ 3969 PARTNERSHIP Q# 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 I CELL EMAIL csheaeld callmurphys.com 11 klaubet callmurphys.com G1/f ROUGH GAS INSPECTION NOTES TIIIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES J Yes No // THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ lC eW( ' FEE: $ PERMIT# /� //�r�� `>C v(-1 C PLAN REVIEW NOTES CSG/V (l�/ /1/V 'ZIP. 71-dl("; / 1d /?