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HomeMy WebLinkAboutBLDG-23-003608 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY YARMOUTH MA DATE January 03,2023 PERMIT# BLDG-23-003608 •ti JOBSITE ADDRESS 123 WIANNO RD OWNER'S NAME Donald Enos G OWNER ADDRESS 123 WIANNO RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 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 _ a 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 ellenrcaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK E 19 �uhi= CITY Yarmouth MA DATE 12/27/2022 PERMIT# L3 — 3C-,cs JOBSITE ADDRESS '123 WiannoRoad �.. OWNER'S NAME r Donald Enos OWNER ADDRESS sam e TEL 104 465 0551 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL= EDUCATIONAL RESIDENTIAL ' PRINT CLEARLY NEW:; i� RENOVATION: � REPLACEMENT:' ;` PLANS SUBMITTED: YES NO; , ' ' , ', ; '' ' '''' ' APPLIANCES 1 FLOORS--4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .� .. . BOOSTER L CONVERSION BURNER COOK STOVE , DIRECT VENT HEATER ; DRYER FIREPLACE FRYOLATOR FURNACE i` GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT gyp' OVEN POOL HEATER -, ROOM/SPACE HEATER I ,..; ROOF TOP UNIT , TEST UNIT HEATER UNVENTED ROOM HEATER , WATER HEATER OTHER all,�.� 1 m 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 % , 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. 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 appl atio 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 II be' complia ith e ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME William B.Holmes LICENSE# 45 UR MP MGF ' JP JGF ? LPG!: CORPORATION°i I# 043585106 ,PARTNERSHIP # LLC # COMPANY NAME:,RCA Electrical Contractors Inc ADDRESS 153 Commercial St. CITY Mashpee STATE MA ZIP 02649 TEL.508-428-0449 FAX CELL EMAIL ellen@rcaelectnc.com ...