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HomeMy WebLinkAboutBLDG-23-002955 TM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 29,202; PERMIT# BLDG-23-002955 I; JOBSITE ADDRESS 71 SMITHS POINT RD v► tlfr„sc OWNER'S NAME NOLEN CHRISTIAN G OWNER ADDRESS 57 RUSSELL AVE WATERTOWN MA 02472 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ 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/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 LICENSE# 4592 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RCA ELECTRICAL CONTRACTORS ADDRESS. 9 Hunters Trail, CITY Sandwich STATE MA ZIP 025632701 TEL 5084280449 FAX CELL EMAIL ellen(a,rcaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK M. — CITY Yarmouth �,_,_ MA DATE; 11/21/2022 �'PERMIT# 3 2 9 J- t. JOBSITE ADDRESS 71 Smiths Point Road— e D ���S} }�}� � OWNER'S NAME Christian&Susan Nolen-Denny G OWNER ADDRESS 71 Appleton Street Cambridge,MA 02138 TEL 857-212-9664 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL I CLEARLY NEW., i RENOVATION: ,` REPLACEMENT:' . PLANS SUBMITTED: YES NO i, APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER F COOK STOVE DIRECT VENT HEATER DRYER FIREPLACEo FRYOLATOR FURNACE GENERATOR GRILLE e _ INFRARED HEATER =� � s LABORATORY COCKS = MAKEUP AIR UNIT OVEN POOL HEATER . ROOM/SPACE HEATERo P gym, ROOF TOP UNIT ' TEST 1UNIT HEATER UNVENTED ROOM HEATER WATER HEATER o OTHER o o o INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I i NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE 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 CHECK ONE ONLY: OWNER x AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati are true and accurate to the est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b n co pliance w' I P ' en rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME'William B.Holmes LICENSE# 4592-M SIG A E MP MGFa +,a JP JGF LPGI' CORPORATION i o#'043585106 :PARTNERSHIP # COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 153 Commercial St. CITY Mashpee STATE` MA ZIP 02649 TEL 508-428-0449 FAX CELL EMAIL ellen@rcaelectric.com