HomeMy WebLinkAboutBldg-19-004188 SO#135759 $60
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY YARMOUTH MA DATE;1/9/19 y a PERMIT#/ -4 &-00In fT
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JOBSITE ADDRESS 488 ROUTE 28 _ OWNER'S NAME HOLIDAY VACATION CONDOS
GOWNER ADDRESS SAME 1 TEL 508-775-0414 'FAX;
TYPE OR OCCUPANCY TYPE COMMERCIAL. a EDUCATIONAL RESIDENTIAL° �
PRINT
CLEARLY NEW: RENOVATION:! REPLACEMENT:`Y%�' PLANS SUBMITTED: YES „ NO
APPLIANCES 7 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER INIIIIIIIIIIIIIIIIIIIIMINNINININNIMISININIIIIIIIIMIIMMIIIIIIIIII
COOK STOVE
DIRECT VENT HEATER IIIMIIIIIIIIIIIIIIMININININIIIIIIIIIIIIIIIIIIINFOMINIIIIIIIIII
DRYER
GENERATOR Tait IIIIIMIIMMINIMIIIIIIIIIIIIIIIIIIII nionotimi Imo
GRILLE nitwatamr- 1 i
MAKEUP AIR UNIT alissoilitionmanrilitiiiiiintiostrominitsationiiii
OVEN
ROOF TOP UNIT
TEST •1111' allainall7MairmilisrmiminRintlimistan
UNIT HEATER I
UNVENTED ROOM HEATER
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WATER HEATER. ;
OTHER GAS isistmamononiiineitniel
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MN, ININIIIIIIIIMINININNIN
IIIIIIIII MINE NW 1111"111111MAINIII
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES J,I NO ,,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 2„ OTHER TYPE INDEMNITY J BOND 1-1
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 1_1 AGENT nj
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applicatio 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 b i m liance ' 'nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Richard J.Whiteside I LICENSE# 15850 SIGN
MP MGF: 7 JP 71 JGF Li LPGI;, > CORPORATION # 3969 'T PARTNERSHIP I LLC. `#—
COMPANY NAME:;Murphy Services Inc �a ADDRESS 34 Whites Path `
South Yarmouth STATE E MA ZIP,02664 TEL€508-760 1660 -•
CITY So _.. „.-- . , - — L. .
_. _ _ ..
FAX'508-760-1670 CELL 1EMAIL`csheaa@callmurphys.com I/ klaube@callmurphys.com
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
Nl& THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
ft#- &//5 PLAN REVIEW NOTES `� &