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HomeMy WebLinkAboutBLDG-22-007241 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ° CITY YARMOUTH MA DATE June 15,2022 PERMIT# BLDG-22-007241 JOBSITE ADDRESS 11 BLUE ROCK RD OWNER'S NAME BEGIN ROBERT M SR G OWNER ADDRESS BEGIN KATHERINE T P 0 BOX 473 HARDWICK MA 01037 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—. BSM 1 2 3 i 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 ❑ 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 LICENSE# 4592 SIGNATURE MP❑MGF 0 JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: RCA Electrical Contractors ADDRESS. 19 Hunters Trail, CITY Sanwich STATE MA ZIP 025632701 TEL FAX CELL EMAIL I S31ON M31A321 Ndld #1IW213d $:33d 11W213d 3H1 Sd S3A213S NOI1d01lddd SIHJ ON saA S3ION N01103dSNI 1VNId KINO 3Sf12101O3dSNI 210d 3OVd SIHI S3 LON NO103dSNI SVO HOf1021