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HomeMy WebLinkAboutBLDG-23-002954 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :'; CITY 'YARMOUTH MA DATE 'November 29,202', PERMIT# BLDG-23-002954 h JOBSITE ADDRESS 122 SQUIRREL RUN OWNERS NAME 'SPARKS LILLIAN G OWNER ADDRESS 22 SQUIRREL RUN YARMOUTH PORT MA 02675-1834 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 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 0 JGF❑ LPG' 0 CORPORATION❑# I PARTNERSHIP ❑#I LLC ❑#I COMPANY NAME: IRCA ELECTRICAL CONTRACTORS I ADDRESS. 19 Hunters Trail, CITY (Sandwich ISTATE MA ZIP 1025632701 I TEL '5084280449 FAX ( I CELL I I EMAIL Iellen(a)rcaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .; ati CITY Yarmouth MA DATE'11/23/22 PERMIT# JOBSITE ADDRESS 22 Squirrel Run OWNER'S NAME Janice Sparks G OWNER ADDRESS 'same TEL 781-704-9681 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS—I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER d COOK STOVE DIRECT VENT HEATER 1 DRYER FIREPLACE FRYOLATOR FURNACE �: ,wa GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT 1 ,. ; iz OVEN 9 .a ,e POOL HEATER i ROOM/SPACE HEATER ROOF TOP UNIT TEST f �. m. 1..,: -I-.... . ... . UNIT HEATER w UNVENTED ROOM HEATER WATER HEATER r OTHER gg d Y T INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES G ! 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. 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 application ar true d accura th st my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c i c II in o ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME WilliamB.Holmes LICENSE# 4592-M IGNATURE MP MGF JP JGF LPGI 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