The URL can be used to link to this page

Home My WebLink AboutBLDG-23-002780 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK gY %; CITY YARMOUTH MA DATE November 18,202, PERMIT# BLDG 23 002780 JOBSITE ADDRESS 7 WOODSIDE CIR OWNER'S NAME Matthew Hatch G OWNER ADDRESS 7 WOODSIDE CIR YARMOUTH PORT MA 02675-1800 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ 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 GENERATOR 1 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY❑ BOND 0 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 William Holmes LICENSE# 4592 SIGNATURE MP 0 MGF LI JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: RCA ELECTRICAL CONTRACTORS ADDRESS. 9 Hunters Trail, CITY Sandwich STATE MA ZIP 025632701 TEL 5084280449 FAX CELL EMAIL ellenna rcaelectric.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --MOM t •' =u 1 CITY Yarmouth • MA DATE 11/11/2022 PERMIT #_ 2 -/ .._.... vddridd,/e%1(.4wilea7///bL(a/..:✓Wvdib/N '.4/2:d%/bi.::/iwiGda,/h/✓.o GLa/Jaa,.,,444.7ndibZerib%G .in :;.iGr ht'dNlrupi GVG..v r -4��' ............:...,.....:w............:...:..�......a...:......:.....,......�........�.....�e..w.u..w...=: .........me....wam.....wrm:..maamn.......ualw� ....n.�.�...Amon�m. ... s. ,�..-......::...:. JOBSITE ADDRESS 7 Woodside Circle OWNER'S NAME Matthew Hatch ....:...... ... ........... .......:... :;....::.i;' .fkW�d6ddRR2l//G/Gbrib/viaw.:, .. :..�:uwilv4:d�Je�nG2Yat2SSSR.2R"'�" H/bY.:S4k'✓/a4LCbW.Nor..:�.::.. ... OWNER ADDRESS same s TEL 508 728 1519W,�G- FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL -1EDUCATIONAL '„ RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO f APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 I 8 9 10 11 12 13 14 BOILER BOOSTER - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST 1 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 a Iicati n are true .•- ac .te the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicatio i b in c pli. r wi P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER-GASFITTER NAME ` William B. Holmes LICENSE # 4592-M j SIGNATURE -. -� MP MGF JP � JGF Leddu LPGI �� CORPORATION # 04358510 6 PARTNERSHIP Iu -�..�..w. _w�.dm�,.ww.�.�.m.:..._�...,m.r..w:a.�.....�.�w.....:.:.:...............w..:.k.w.....�.:�.....,.............�......�.�,. .....:�m�.-,.��.�....u...w..ww...�..�w...�.. COMPANY NAME: RCA Electrical Contractors Inc. ADDRESS 153 Commercial St. CITY Mash pee p STATEEMA ZIP 02649 - TEL 50$ 42$ 0449 FAX _ .w.,. __..-.. ...._-,.. m ;: CELL. EMAIL ellen@rcaelectric,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 if I