HomeMy WebLinkAboutBLDG-19-003101 SO#135151 $50
r - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE 11/12/18 PERMIT#fi b/7 l
JOBSITE ADDRESS 2 RED JACKET RD :OWNER'S NAME SCOTT ROBBINS G
OWNER ADDRESS PO BOX 134 YARMOUTHPORT MA 02675 TEL 508-737-1135 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: REPLACEMENT: l PLANS SUBMITTED: YES NO 1
APPLIANCES Z FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER i
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
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GRILLE
INFRARED HEATER :;.
LABORATORY COCKS
MAKEUP AIR UNIT
s
OVEN
POOL HEATER
ROOM/SPACE HEATER i
ROOF TOP UNIT
TEST _;i.,
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER _ 1
OTHER F , „
..........ter, ,... .
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 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 ON 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 applicatio ere true nd accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will b I m fiance with all Pertinent provision of the
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Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I I ' ► - tie
PLUMBER-GASFITTER NAME Richard J.Whiteside yy LICENSE#1 15850 SIGNATUR
MP i MGF JP JGF LPG!. _ CORPORATION #;3969 PARTNERSHIP #? LLC #;
COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL;508-760„1660
FAX 508-760-1670 CELL EMAIL;cshea@callmurphys.com // klaube@callmurphys.com
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ROUGH GAS INSPECTION NOTES TIIIS PACE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES