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HomeMy WebLinkAboutBLDG-23-005062 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tf, CITY YARMOUTH MA DATE March 15,2023 PERMIT# BLDG-23-005062 I1 JOBSITE ADDRESS 104 CHIPPING GREEN CIR OWNER'S NAME CHRISTINE OLEARY OWNER ADDRESS GERARD DOUGLAS 19 BAYSIDE ST DORCHESTER 021250000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO El 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 1 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 © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El 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. 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❑ MGF © JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RCA ELECTRICAL CONTRACTORS ADDRESS. 9 Hunters Trail, CITY Sandwich STATE MA ZIP 025632701 TEL 5084280449 FAX CELL EMAIL ellenta�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 t. slim CITY ;Yarmouth MA DATE 3/7/2023� #PERMIT el - Z 3 ODcS06 JOBSITE ADDRESS Ll04 Ch ppin9 Green Circle !OWNER'S NAME I Christine O'Leary G OWNER ADDRESS I same TEL 617 201 4333 FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ._. RESIDENTIAL i',% PRINT CLEARLY NEW: i RENOVATION:I� W REPLACEMENT: ' PLANS SUBMITTED: YES j m NO,y, 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 i i, . .. FIREPLACE r � FRYOLATOR l �_ FURNACE M. GENERATOR IIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIINIIIIMIIIIIINIIIIIIIIIIIIIIISIIIIIIIIIII GRILLE INFRARED HEATER a l LABORATORY COCKS MAKEUP AIR UNIT .._....� . _mom _�__ ,�._:_� ..._. 1 OVEN ,. �, .�_. POOL HEATER t ROOM I SPACE HEATER i ° ' _ h ROOF TOP UNIT TEST 1 I UNIT HEATERi. UNVENTED ROOM HEATER - r WATER HEATER_.... ... _ r, OTHER I , d : m _� __ f I f4 f s INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L' NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 ! , 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 rw-. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this ap atio are true cc to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application it e li 't e ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME j William B.Holmes F LICENSE# 4592-M SIGNATURE MP MGF JP " JGF LPG' CORPORATION; + # 043585106 PARTNERSHIP" #; LLCI ,#I ...aa COMPANY NAME:1 RCA Electrical Contractors Inc. ADDRESS 153 Commercial St. CITY I Mashpee STATE MA ZIP 02649 T ,��: y t FAX' j CELL: ,EMAIL'ellen a@rcaelectric com 1 Lj DEPAR1 BY.---- 7�—YY-' 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