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HomeMy WebLinkAboutBLDP-19-003935 J13179 $50 j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'eitillar _- l=yt CITY YARMOUTH MA DATE 1/2119 PERMIT# /94/96-^/9-0611,1 JOBSITE ADDRESS 2 MAUSHOPS PATH OWNER'S NAME BILL KELLEY GOWNER ADDRESS 3 ORCHARD ST BERKLEY,MA 02779 TEL 774-470-5032 $FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER I CONVERSION BURNER _- COOK STOVE I' DIRECT VENT HEATER ( ;. `- II i, , �„ II I . .� _ as .,.W DRYER tea_ .G I .„- I ' ' ii I €l I FIREPLACE - N , FRYOLATOR d H' FURNACE 1 — 4 .\, , _ . I I� GENERATOR 1 _. . _GRILLE I. I . INFRARED HEATER ' LABORATORY COCKS I 1 k I I l ' , I ' MAKEUP AIR UNIT Ir i VEN POOL HEATER •'• nrrerrlR ROOF TOP UNIT ali III ,1 as , 1 . . . 1 1 i TEST T- WATER HEATER ' 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❑' 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 0 1 Y: 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 are./ . ac urate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be intX11 h e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I / PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 SIGNATURE MP E MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION Q# 3969 PAR ERSHIP❑# 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 I/ klaube©callmurphys.com 6 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �J�/ a FEE: $ PERMIT# (/'' - 'C " ^� PLAN REVIEW NOTES ////� 7