HomeMy WebLinkAboutBLDP-17-005231 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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�q CITY Yarmouth MA DATE 4/5/17 PERMIT# �,-17 "ij
/I/.)p JOBSITE ADDRESS 116 Captain Smalls OWNER'S NAME Darlene McCarthy
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OWNER ADDRESS ,Same TEL IFAX
TYPE OTR OCCUPANCY TYPE COMMERCIAL j EDUCATIONAL 7,j RESIDENTIAL'PRIN
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CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER .,,____ ' w €a ... . _ .0
BOOSTER iijI
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CONVERSION BURNER f =, -1°_ `— ,___ 1;_:_j
COOK STOVE : t _ . ,. w1 .
DIRECT VENT HEATER ._ .I .M . I _,...j-. _____ �:_H- ,rn,i __,..,4..��
DRYER ..1° ,_....,I . ._,,J!_...._,I _ l .. _I, .I-.. ,.. 'y
FRYOLATOR [ .I_,.� __..J ®I `____I
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FURNACE ®.®®J J �I. ,., .:. I m- I__ - .__.I ........_�„1-•
GENERATOR I . 5 .IL I ,, 1 _ i' , . f_1 -
GRILLE .J ... i...., e__f_t=_I_J____.1J'_, !.... !a ., ®..1'__
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INFRARED HEATER I _ J _J;_,_..�, .__; ''- _u I I• --i• I I
LABORATORY COCKS _1_._� ,.I._�_J `__� ....-_e_ 'a�__.__I' 1 a I 1__ _._I__._.
MAKEUP AIR UNIT ,]- J. �� �__ I .I
OVEN a. ,... . ,. _�. I . I J I ,.0 I
POOL HEATER „ y�. t ,�. J I` I ._.. J . -1'... ti J __ J';.
ROOM/SPACE HEATER _ I '_ ___ _I,_� i I?_ _J' _ ._ ..J I I.
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ROOF TOP UNIT I I — t I ®J ..� §_- _ _ y _T -1
TEST I I I_ 'T I Lam. I I f t I
UNIT HEATER � _ ' `
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UNVENTED ROOM HEATER i '.� f � . J._. .I ,,--I 1..._1
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WATER HEATER __1___I' . _ I _.__.�J._�...1 I_�.,. i .. 1 ,ee I____`s_..____J..____..,.,
OTHER
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES FA NO J
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ::„„,,,j BOND J
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 ,r,jj AGENT 1
SIGNATURE OF OWNER OR AGENT
I 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 complianc 'th all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /10h
PLUMBER-GASFITTER NAME Frank RoderickLICENSE#=7794 SIGNATURE
MP !I MGF JP J JGFJ LPG' CORPORATION%#€ 1762-C I PARTNERSHIP #° LLC j#
COMPANY NAME: Rus 's Inc. ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth _� __ STATE MA ZIP'02673 , JTEL 508-775-
1303 .
FAX 508-771-9310 1 CELL IEMAIL;ssave rus sinc.com