HomeMy WebLinkAboutBLDG-19-003036 SO#134294 $70
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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�� CITY YARMOUTH MA DATE 10/29/18 PERMIT#pm� 6 ` 9CTY.
JOBSITE ADDRESS 1311 ROUTE 28 OWNER'S NAME YARMOUTH HOUSE OF PIZA Z
GOWNER ADDRESS SAME TEL 508-292-6098 FAX;
TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: iy RENOVATION: i„ REPLACEMENT: PLANS SUBMITTED: YES 7 NO 7,
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
GENERATOR
GRILLE i_.
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN 3
POOL HEATER
ROOM/SPACE HEATER F...,,, . .
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER 1 i_.
OTHER
, , t.. A ,... ..
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 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 application . - ue ant accur- --to-the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be ;=fiance all Pertine .rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 SIGNATURE
MP i MGF „_ JP JGF j 'LPGI CORPORATION` # 3969 PARTNERSHIPS#' I LLC' # i
COMPANY NAME Murphy Services Inc 3 ADDRESS 34 Whites Path
CITY South Yarmouth J STATE MA I ZIP 02664 TEL 1508 760-1660
FAX 508 760 1670 'CELL EMAILa cshea@callmurph�fs.com // klaube@callmurphys.com
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR LISG ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES