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HomeMy WebLinkAboutBLDG-23-002388' f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "' =i CITY YARMOUTH MA DATE November 01,202; PERMIT# BLDG-23-002388 JOBSITE ADDRESS 5 NIMBLE HILL DR OWNER'S NAME MEYMARIS PAUL M TR G OWNER ADDRESS MEYMARIS RLTY TRUST 5 NIMBLE HILL DRIVE YARMOUTH PORT MA 02675-2190 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 I 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# 14592 SIGNATURE MP 0 MGF © JP❑ JGF❑ LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IRCA ELECTRICAL CONTRACTORS ADDRESS. 19 Hunters Trail, CITY (Sandwich STATE (MA I ZIP 1025632701 TEL 15084280449 FAX I I CELL I I EMAIL Iellen(a.rcaelectric.com /N _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r=51G-. '_®ui CITY Yarmouth MA DATE 10/25/2022 PERMIT# 27- Z 3 �� JOBSITE ADDRESS 5 Nimble Hill Drive OWNER'S NAME Carol Meymaris GOWNER ADDRESS same TEL 508-737-6045 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL + PRINT 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 BOOSTER �.. CONVERSION BURNER COOK STOVE n �. m z DIRECT VENT HEATER DRYER . FIREPLACE FRYOLATOR 1 , FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 F UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 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 1 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 app' ation 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 complian ith a Pe 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 + # 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@rcaelectric.com