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HomeMy WebLinkAboutBLDG-23-004918 f; i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 08,2023 PERMIT# BLDG 23 004918 a-=jj JOBSITE ADDRESS 6 SCOOP CIR OWNER'S NAME 'MURPHY CORAL A TR G OWNER ADDRESS MURPHY FAMILY RLTY TRUST 6 SCOOP CIR YARMOUTH PORT MA 02675 TEL I I TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL El CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO El 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 I LICENSE# 14592 I SIGNATURE MP❑ MGF © JP❑ JGF 0 LPG! El CORPORATION Cl#I I PARTNERSHIP ❑#I ILLC ❑# COMPANY NAME: RCA ELECTRICAL CONTRACTORS ADDRESS. 19 Hunters Trail, CITY (Sandwich STATE IMA I ZIP 1025632701 I TEL 15084280449 FAX CELL 1 I EMAIL lellen(@scaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1'®g+ MA DATE'2/28/2023 PERMIT# j � ` �3'G��%�/� F CITY Yarmouth tk JOBSITE ADDRESS 6 Scoop Circle OWNER'S NAME 'Cord Murphy GOWNER ADDRESS i same ,TEL 508-361-4457 FAXr ,,,.,„,„„,rv..uonwawW__ee;i 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 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER =n 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1 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. 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 ication 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 ill b n complias wit, P_ inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 111/ PLUMBER-GASFITTER NAME William B. Holmes LICENSE# 4 S' le ATURE MP MGF 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 �w,a1