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HomeMy WebLinkAboutBLDG-23-004119 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 25,2023 PERMIT# BLDG-23-004119 JOBSITE ADDRESS 1180 ROUTE 6A OWNER'S NAME HORGAN PATRICK A G OWNER ADDRESS SPRINKLE CHERYL P 0 BOX 852 YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El PRINT RESIDENTIAL 111 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 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 El 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 pel'Mit 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 I I LICENSE# 14592 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 ellen(c1rcaelectric.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK U n CITY Yarmouth MA DATE 1/18/23 PERMIT# 23 — e!//7 JOBSITE ADDRESS 180 Route 6A �r--� OWNER'S NAME Krishna Sprinkle G OWNER ADDRESS same TEL 508-776-8779 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-0 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 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I'_,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. 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 a and that all plumbing work and installations performed under the permit issued for this application II be " co •lia ith Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PP atio are true and accurate t. e best of my knowledge 'e ent provision of the PLUMBER-GASFITTER NAME William B. Holmes t w' !� LICENSE# 45•�- I °`+ATURE MP MGF JP JGF LPGI CORPORATION # 043585106 PARTNERSHIP # COMPANY NAME: RCA Electrical Contractors Inc. LLC # ADDRESS 153 Commercial St. CITY Mashpee STATE MA ZIP 02649 TEL 508-428-0449 FAX CELL EMAIL ellen@rcaelectric.com z z w z z w a ZO z - � 2 F 0 W. 2 cn cn z a a Nz LLI W Z a o d � a U_ x J a c w = w f- LL O z z 0 H z d 0