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HomeMy WebLinkAboutBLDG-23-005273 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'rb CITY YARMOUTH J MA DATE March 24,2023 PERMIT# BLDG 23 005273 JOBSITE ADDRESS 8 TIDE LN OWNER'S NAME KERRY KING G OWNER ADDRESS 19 ELDREDGE LN COHASSET 02025-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 1 BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR 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 Richard Whiteside LICENSE# 15850 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MURPHY'S SERVICES,LLC ADDRESS. 34 White's Path, CITY South Yarmouth STATE MA ZIP 026641212 TEL FAX CELL EMAIL 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 PROJECT 72233327 JOB 50199-001 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IF CITYPERM IT # z ' `665-2 7- ) JOBSITE ADDRESS 8 Tides Lane _ `�� OWNER'S NAME King GOWNER ADDRESS 51 Fords Crossing, Norwell, MA TEL 617-529-3751 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL I I EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 - BOOSTER I CONVERSION BURNER COOK STOVE 1 _ DIRECT VENT HEATER r Y I _ �, _ DRYER FIREPLACE 1 FRYOLATOR FURNACE ____ f ii- --= GENERATOR GRILLE _ i INFRARED HEATER __ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER = ......1 ROOM I SPACE HEATER ; ROOF TOP UNIT TEST UNIT HEATER i_ 1� UNVENTED ROOM HEATER j WATER HEATER OTHER I Gas test 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ,_i _ NO Fj I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1� 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 Mas hu efts General Laws, and that my signature on this permit application waives this requirement. J CHECK ONE ONLY: OWNER AGENT 1 SIGNATURE OF OWNER OR AGENT ,,I I hereby certify that all of the details and information I have submitted or entered regarding this application are tr d c rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cotri I. e i all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ' Richard J. Whiteside LICENSE #E 15850 SIGNATUR MP ' ' = MGF JP L__J JGF LPG' CORPORATION # PARTNERSHIP, # LLC i # 4611 COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ' ZIP 102664 TEL 50 0 0 FAX 508-760-1670 ] CELL EMAIL cshea@callmurphys.com 11 jridlon@callmurphys.com MAR 24 2023 BUILDING DEPAR ( T. - I By.