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HomeMy WebLinkAboutBLDG-22-003372 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE (December 14,2021 PERMIT# BLDG-22-003372 JOBSITE ADDRESS 13226 HEATHERWOOD I OWNERS NAME SCHOFIELD JEANNE K TR G OWNER ADDRESS THE 1995 SCHOFIELD FAMILY INV TRUST 3226 HEATHERWOOD YARMOUTH PORT TEL I MA 02675 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO 0 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 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 LIABILITY INSURANCE POLICY Q 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 I LICENSE# 115850 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑#I COMPANY NAME: 'Murphy Services,Inc. ADDRESS. 134 White's Path, CITY 'South Yarmouth I STATE MA ZIP 102664 I TEL '5087601660 FAX 1 .CELL I IEMAIL I S310N M3IA321 NVld #11Mad $ :33d El El 111N2i3d all SV S3AH3S NOI1VOIlddV SIHI ON SOA S310N NO1103dSNI 1VNH AlNO 3Sf1 HO133dSNl JIDd 30Vd SIH1 S31ON N01103dSNI SYD HOflO