HomeMy WebLinkAboutBLDG-19-005012 J13219 $50
. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE 2/13/19 PERMIT#17/ `C7 f
JOBSITE ADDRESS 22 NORTON RD a OWNER'S NAME SARAH WALSH
GOWNER ADDRESS PO BOX 214 SOUTH HARWICH,MA 02661 TEL 7747 208-4925 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: ' REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES 1 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 ' I _ 4
e
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST I'
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES . i'NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i 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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE.{JNLY: OWNER sue AGENT ,.,
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application tr e a d accur the of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be i co lia all P ' e provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i r
PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 S NATURE
MPS MGF JP JGF LPG' CORPORATION # 3969 PARtNRSHIP # e,. LLC� #
COMPANY NAME Murphy Services Inc I ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660
FAX 508 760 1670 CELLI cEMAIL cshea@callmurp y . klaube@callmurphys.com
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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