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HomeMy WebLinkAboutBLDG-21-006889 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 . CITY YARMOUTHk, MA DATE May 26,2021 PERMIT# BLDG 21 006889 JOBSITE ADDRESS 80 MATTAKESE RD UNIT 9 OWNER'S NAME FAY PAMELA JOAN G OWNER ADDRESS 80 MATTAKESE RD APT 9 WEST YARMOUTH MA 02673-5055 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 1 , GENERATOR GRILLE , INFRARED HEATER LABORATORY COCKS _MAKEUP AIR UNIT J OVEN £�/£J , POOL HEATER /2 ROOM/SPACE HEATER • r ,..1.,..-/- ROOF TOP UNIT TEST £44_ UNIT HEATER , UNVENTED ROOM HEATER , WATER HEATER , OTHER I • t 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 0 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 Richard Whiteside LICENSE# 15850 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Murphy Services,Inc. ADDRESS. 34 White's Path, CITY South Yamouth STATE MA ZIP 02664 TEL 5087601660 FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 /,LFO =-//um-c FEE:$ PERMIT# /Ai A1TIC '.vo ACCESS' PLAN REVIEW NOTES