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HomeMy WebLinkAboutBLDG-23-001634 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t ' CITY YARMOUTH MA DATE September 27,202 PERMIT# BLDG-23-001634 JOBSITE ADDRESS 1 KENCOMSETT CIR OWNER'S NAME MARCOURT INVESTMENT LLC G OWNER ADDRESS 16 KENCOMSETT CIR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL al 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNERS 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 0 JP 0 JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RCA ELECTRICAL CONTRACTORS ADDRESS. 9 Hunters Trail, CITY Sandwich STATE MA ZIP 025632701 TEL 5084280449 FAX CELL r EMAIL ellen(a,rcaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -•w �� CITY °Yarmouth c MA DATE 9/20/22 PERMIT# 2 3-- l G 3 1 JOBSITE ADDRESS 1 Kencomsett Circle OWNER'S NAME Pamela Parker G OWNER ADDRESS F same TEL 954-803-1291 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL , RESIDENTIAL CLEARLY NEW. i RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO i APPLIANCES-1 FLOORS-. BSM 1 2 ' 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER a ,r CONVERSION BURNER COOK STOVE . m,..; DIRECT VENT HEATER DRYER a ... Jr FIREPLACE FRYOLATOR FURNACE GENERATOR n . GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT " " ._ .- <.., .. OVEN POOL HEATER _ - a_ - ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER = OTHER ; . r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES r 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 f 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 applicat'.n 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 . in . pliance with all Pertine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME William B.Holmes / LICENSE# 4592- 7 p SI t_`''_ MP MGF i� JP JGF LPG' CORPORATION 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@rcaelectric.com