The URL can be used to link to this page

Home My WebLink AboutBLDG-23-004562 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH;1/4„ MA DATE (February 16,2023 PERMIT# BLDG-23-004562 JOBSITE ADDRESS 1100 HIGGINS CROWELL RD OWNER'S NAME IEATON THOMAS S G OWNER ADDRESS 'EATON JUDITH A 100 HIGGINS CROWELL RD WEST YARMOUTH MA 02673 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES ❑ 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 FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER . LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER • • 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❑ 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. 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. PLUMBER-GASFITTER NAME 'William Holmes I LICENSE# 14592 I SIGNATURE MP❑ MGF 0 JP 0 JGF❑ LPG( ❑ CORPORATION 0#I I PARTNERSHIP 0 It I ILLC ❑#1 I COMPANY NAME: 'RCA ELECTRICAL CONTRACTORS I ADDRESS. 19 Hunters Trail, I CITY 'Sandwich ISTATE MA ZIP 1025632701 I TEL 15084280449 FAX I ICELL I I EMAIL 'ellenna,rcaelectric.com I 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MtlI CITY E Yarmouth MA DATE 2/9/2023 PERMIT# 8/-86-2 S70Z., JOBSITE ADDRESS 100 Higgins Crowell Road OWNER'S NAME ,Tom&Sara Johnson GOWNER ADDRESS same TEL 774-209-0457 FAX x TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: i RENOVATION:� , REPLACEMENT: ' � PLANS SUBMITTED: YES NO j�„ APPLIANCES 1 FLOORS-i BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I BOOSTER �.. I, y.::. t CONVERSION BURNER , a �i € If COOK STOVE I DIRECT VENT HEATER DRYER FIREPLACE i , , ..... : .. .., �. o. . FRYOLATOR i ; , ; , FURNACE , eeme l> GENERATOR 1 GRILLE : . r INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ( ',6 i r l OVEN POOL HEATER s ROOM/SPACE HEATER § 4 ROOF TOP UNIT TEST 1 1 UNIT HEATER 9 3 3 k ,�,ram. ._a, a,�,w UNVENTED ROOM HEATER , g WATER HEATER .._€ OTHER _,. 9 , -,w.'.� „„. M i is v<� e� .,. ..h.... ;..... , ,..K >, ' a INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [/ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ei OTHER TYPE INDEMNITY BOND I 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 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applic ion a true and accurate to t best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will e in mpli nc al rtin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I William B.Holmes ;LICENSE# 4592- S N URE MPF-- MGF, JP h JGF ; LPG' CORPORATION / # 043585106 PARTNERSHIP #. LLC a# COMPANY NAME.RCA Electrical Contractors Inc. ADDRESS.153 Commercial St. CITY Mashpee STATE° MA ZIP'02649 TEL 518 , t:-=`4a FAX CELL EMAIL,ellen@rcaelectric.com 16 13' . BUILDING ucPAi-Ci M>=NT By: