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HomeMy WebLinkAboutBLDG-23-000754 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g CITY 'YARMOUTH I MA DATE 'August 15,2022 I PERMIT# BLDG-23-000754 "L`11 JOBSITE ADDRESS 14 RICHARD RD OWNER'S NAME WHITFIELD GORDON A TRS G OWNER ADDRESS WHITFIELD JOAN 0 14 RICHARD RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED:YES❑ NO 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 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 LABILITY 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 as 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❑ LPG' 0 CORPORATION❑# 1 PARTNERSHIP ❑# LLC❑# COMPANY NAME Murphy's Services.LLC ADDRESS. 34 White's Path, CITY South Yarmouth STATE MA ZIP 02664 TEL LS087601660 FAX CELL EMAIL S310N MIANOIARI NVld #±I1Al2:13d $ :33d ❑ ❑ 1.J1M:13d 3H1 SV S3AH3S NOI1d0IlddV SIHJ oN saA S31ON NOI103dSNI 1VN13 AlNO 3Sl 210103dSNI 2JOd 3OVd SIH1 S310N NOI103dSNI SVO Fiona'I