HomeMy WebLinkAboutBLDG-19-000467 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY SOUTH YARMOUTH MA DATE 7/17/18 PERMIT# &'/? 000716 7
JOBSITE ADDRESS.6 PARKWOOD COURT OWNER'S NAME CATHERINE SCHNEIDER
GOWNER ADDRESS 95 LINCOLN ST DUXBURY MA 02332 TEL 781 307 2672 FAX,
TYPE OR ...
PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
CLEARLY NEW: RENOVATION: - REPLACEMENT: i PLANS SUBMITTED: YES I NO
APPLIANCES 7 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
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 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 ONLY: OWNER AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applicati tr e and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will b iance with all Pertin nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Richard J•Whiteside LICENSE# 15850 SIGNATURE
MP MGF JP JGF, LPGI:� CORPORATION �i# 3969 'PARTNERSHIP J# LLC '#'
COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path
_.NO?Y —.
CITY South Yarmouth I STATE MO ZIP,02664 TEL 508-760-1660
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FAX;508-760-1670 CELL' 'EMAIL cshea@callmurphys.com // klaube@callmurphys.com __
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