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HomeMy WebLinkAboutBLDG-23-002073 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 18,2022 PERMIT# BLDG-23-002073 JOBSITE ADDRESS 259 OLD TOWNHOUSE RD OWNER'S NAME Julie Prescott G OWNER ADDRESS 259 OLD TOWN HOUSE RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ 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 0 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. 19 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 ,T_ airy �%, "kE�� CITY Yarmouth; MA DATE 10/13/2022 PERMIT# 23'' 20 7 3 JOBSITE ADDRESS`259 Old Townhouse Road 'OWNER'S NAME Julie Prescott G OWNER ADDRESS same TEL 781-710-8119 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL . PRINT CLEARLY NEW: I 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 �,, e._ BOOSTER CONVERSION BURNER COOK STOVE r . DIRECT VENT HEATER DRYER �• FIREPLACE FRYOLATOR FURNACE GENERATOR , r r GRILLE INFRARED HEATER — LABORATORY COCKS MAKEUP AIR UNIT OVEN . - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER ;, �' UNVENTED ROOM HEATER WATER HEATER <, OTHER , r INSURANCE • ERAGE I have a current liability insurance policy or its substantial equivalent which Vmeets the requirements q is of MGL.Ch.142 YES f! 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 l v_ 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 AGENT I hereby certify that all of the details and information I have submitted or entered regarding this ap icati are true and accurate t the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application i b n co plia it P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME`William B.Holmes _ LICENSE# 4592- SI NATURE MP: MGF : JP! JGF; LPGI; CORPORATION / #;043585106 6 06 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