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HomeMy WebLinkAboutBLDG-22-002399 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e' c' CITY YARMOUTH MA DATE October 26,2021 PERMIT# BLDG-22-002399 JOBSITE ADDRESS 63 BOXBERRY LN OWNER'S NAME SULLIVAN GEORGE L II G OWNER ADDRESS CIO MURPHY COLM 24 WINTHROP PARK QUINCY MA 02169 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF 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. SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME (William Holmes LICENSE# 14592 SIGNATURE MP 0 MGF© JP 0 JGF 0 LPGI 0 CORPORATION❑#I I PARTNERSHIP 0# LLC 0# COMPANY NAME: 'RCA Electrical Contractors ADDRESS. 19 Hunters Trail, CITY 'Sandwich (STATE MA ZIP 1025632701 I TEL 15084280449 FAX 1 CELL I I EMAIL I S310N M3IA32!NVld #111,11:13d $:333 0 0 1IINLI3d 31-11 SV S3AZI3S N011VOIlddd SIHI oN seA S310N NOI103dSNI 1VNH AINO 3Sf12l0103dSNI 2103 30Vd SIHI S310N NOI103dSNI SVO H0f1011