HomeMy WebLinkAboutBldg-19-005027 J13226 $75
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
.�l:f�o CITY YARMOUTH„
I MA DATE 2/22/19 PERMIT#i �lt�9-66 wo�
JOBSITE ADDRESS:488 ROUTE 28 OWNER'S NAME ',HOLIDAY VACATION CONDOS
GOWNER ADDRESS =SAME TEL 508-775-0414 ;FAX;
TYPE OR OCCUPANCY TYPE COMMERCIAL; : EDUCATIONAL ' RESIDENTIAL:
PRINT
CLEARLY NEW: RENOVATION: ' REPLACEMENT: PUN
S SUBMITTED: YES NO?,,,
APPLIANCES 7 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE 111111111111111111.1111/11111111,11111.11Mill_ MS
DIRECT VENT HEATER
DRYER 1111--FIREPLACE f '
FRRYOLATOR
FURNACE E _._-. € 1-. ,, , -_� 1
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER 1111.11111111101111111. € i ____
,1111111
ROOF TOP UNIT FOISINIMMISININIIMMIUMNIIIIIII111111 MI
TEST 1101111001111111011111111.111111111101101111,11111111111111.1111111111111111111111
UNIT HEATER �...
UNVENTED ROOM HEATER
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WATER HEATER ;(
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OTHER ;GAS PIPING
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miassimminiamiumwainummerimmissimmown
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 12j NO ;
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 1 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.
CHE•' •NE 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 applicati. e an. -ccurate •the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will .: . .lian -with all Pe ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE#1 15850 1 -SIGNATURE
MP ill MGF JP li JGF LPG'ji CORPORATION?�# 3969 I PARer.HIPLThti i LLC #: 1
COMPANY NAME Murphy Services Inc • ADDRESS;34 Whites Path
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South Yarmouth STATE; MA -ZIP:01 2664 TEL;508-760 1660
CITY 'Sou,.. ...
FAX;508 760-1670 ;CELL ;EMAIL cshea@callmurphys.com // klaube@callmurphys.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
Pi& r C FEE: $ PERMIT# / Liy' "
PLAN REVIEW NOTES
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