HomeMy WebLinkAboutBLDG-18-007395 A So
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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s?,417 CITY Yarmouth Port MA DATE 06/12/18 PERMIT# /Y—Sit/7-0073ir
JOBSITE ADDRESS 90 Kates Path OWNER'S NAME Jeanne Crowley
GOWNER ADDRESS SAME TEL 508-362-2878 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIALU]
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:a PLANS SUBMITTED: YES❑ NO
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER i. 1 I _. _ .' -_9J ._I( , _ �_. [ 1
BOOSTER
CONVERSION BURNER J I
COOK
STOVE . .. I ....., It
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR , {
5o FURNACE
GENERATOR . I _ w
GRILLE I _ .I ., {
INFRARED HEATER . � -+
LABORATORY COCKS 7 _ ;, _-,I_ - _
MAKEUP AIR UNIT
OVEN __-...i
POOL HEATER ---
ROOM I SPACE HEATER .�.v,. .- _ J J
ROOF TOP UNIT -., _ -I _ __ I I__.-1I I 1
TESTS - ._. . _
UNIT HEATER _:
UNVENTED ROOM HEATER _ .m I 1
WATER HEATER I
OTHER L__ . , . i _ I
_ , pro d
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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 are true a • accu -te •th- •-- _ knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli, - wit -II •- e t t•rovi 'on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J.Farnham f I LICENSE# 11601 SIG ATUR
MP Q MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHIP❑# I LLC❑#
COMPANY NAME: South Shore Heating&Cooling,Inc ADDRESS 57 White's Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901
FAX 508-760-2681 CELL EMAIL
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