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I.__yyam_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
` T�—y Yarmouth CITY I,'-� , i MA DATE 15/10/21 PERMIT#
JOBSITE ADDRESS[28 Vine Brook Road I OWNER'S NAME Co ithome j
G1 OWNER ADDRESS I Same as above-02664 - 9 TELL 727-729-1261 1FAX L
TYPE OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL
RESIDENTIAL
CLEARLY NEW:L3 RENOVATION:LI REPLACEMENT:0 PLANS SUBMITTED: YES NO®
APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER PM NMI BOOSTER -��l�tsn.�. `! r .(�.�. �. .�..'�, "lW.-- <I ��.�„_.�-g
CONVERSION BURNERIganan.itkaan,..,.i„....,
Awl/NI init_wwMAJELME
COOK STOVE $11111111 -
DIRECT VENT HEATER ' I rLn
L. i
DRYER �'
.fir_�_1
FIREPLACE R.,-1,10,-----1
I ..-----3------- main-
t' ���r
..
FURNACEFRYOLAT
a n
moanOR I __.�., ! _..... I. �
GENERATOR --[; 31 ,r .;
GRILLE �`!�. :���1- ..��...
INFRARED HEATER I E Y!. JI-v,_- I,. _. ^I !. '! 1 �. 1_ Mi. .�.._a=
LABORATORY COCKS 1_1f� n. I Il J1
MAKEUP AIR UNIT � ��L. — a
� I 1 a. l
OVEN _._ _ �,.�-,�. _
POOL HEATER 1- -- _� � I�.,..�..
ROOM/SPACE HEATER _
ROOF TOP UNITnamiu
., _ a !
TEST al_ .n. I �.r. !
�r It I
UNIT HEATER ,;
imi _ _
UNVENTED ROOM HEATER r ilus,Iniirl:.,
_WATER HEATER ®_____
-111111M11ry °
OTHER
II
.,. _ INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES EJ NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ri OTHER TYPE INDEMNITY j BOND
Lj
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 CHEC`ONE ONLY: OWNER i. AGENT i
I hereby certify that all of the details and information I have submitted or entered regarding this applicatio - 6:nd accurate to t - .est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will b: Al, . .lian,e with . 'ertinent pro' ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �'
PLUMBER GASFITTER NAME!Richard J.Whiteside LICENSE# 15851 J '' ��
... SIGNATURE
MP' i ' MGF'_�,� JP ' ' JGF
D LPG'L CORPORATION I i # 3969 1 PARTNERSHIP[1# LLC #
COMPANY NAME: Murphy Services Inc _.__._ --------- --
ADDRESS 34 Whites Path
CITY rSouth Yarmouth
STATE MAZIP1 02664
TEL 508-760-1660
FAX;508 760 1670 CELL ...
},,,,, EMAIL cshea@callmurphys.com II klaube@callmurphys.corn