HomeMy WebLinkAboutBLDG-18-005197 •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
741- _" CITY Yarmouthport ' MA DATE 3/16/18 PERMIT#/ P/3�`��c
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JOBSITE ADDRESS 40 Old Church St OWNER'S NAME Jud Barnatt I
GOWNER ADDRESS SameI TEL FAX: I
TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL :J RESIDENTIAL hj
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CLEARLY _NEW: RENOVATION:`, REPLACEMENT: 'J PLANS SUBMITTED: YES ill NO
APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I J I I J .,..n I
BOOSTER r.ti
CONVERSION BURNER __J t. J--- I . J __I.__ _ _ u ) I. Ia,_m,J _ I
COOK STOVE I I I I I 1 1° I I I I i ..
DIRECT VENT HEATER I I J J I I I: II
DRYER '----'1' �I I; J® '.
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FIREPLACE �. i
FRYOLATOR '_.j _a_..1__._.I _____I.- . .j .. , J I J. I: v I1 I
._..M €FURNACE __ -J I_„__J ®.._ 1 _r,I _ ____I I I _ _ I ____J
_ffGENERATOR I, __ _ I �_ I
GRILLE -L . . I _ ,. ( J
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INFRARED HEATER I_2_1- ,
LABORATORY COCKS II ,IoJ' I= I .W, I: I _. I' I� I .®ms. I I_____I
MAKEUP AIR UNIT I. _ I I I: .I,___.�I .,,_. .. _.
OVEN I-m : .I ...,,, �....._._I,.�... . .I',,-. .,,.I J'^ g I' .I . I I I �I
POOL HEATER t m . I. . ..I� .I I , � .. ,. . I `- IL-7,-4_11,,
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ROOM/SPACE HEATER ___J . _ .I_.J....1__�J I. .�_.J _.I . f... I .0 _,I..-. . 1 .......J
ROOF TOP UNIT I I r. I , I --,
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TEST -1:_____I
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UNIT HEATER I � „ l �...e ,�,�,,, . .1, _ r ,,.. ., ra. I-_...
UNVENTED ROOM HEATER I I _ � - I J I, I I ..
WATER HEATER 1 I I I.__. _ . ...I
OTHER I �_ I I. . ._I I I I---- e_ I I .. ._I__:___I
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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 lij NO ,,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY mX t BOND LJ.
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 :......,,,J-- 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 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. 604
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PLUMBER-GASFITTER NAME Frank RoderickLICENSE#,7794 SIGNATURE
MP MGF._I JP I JGF _I LPG! . 1 CORPORATION. #` 1762-C PARTNERSHIP, # LLC #
COMPANY NAME:Rustty's Inc. I ADDRESS 222 Mid Tech Drive
CITY West Yarmouth I STATE ,MA 1 ZIP 02673 1TEL 508-775-1303
FAX 508-771-9310 CELL tEMAIL.ssave • rus sinc.com
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