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HomeMy WebLinkAboutG-19-1733 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS b-46-44-40017,FITTING WORK _ ,= CITY Yarmouth , MA DATE 09.17.18 PERMIT# r3 JOBSITE ADDRESS 5 Franklin St Yarmouth Ma OWNER'S NAME Scott McKenzie 3 GOWNER ADDRESS 1284 Thompson Hill Rd Thompson CT =TEL 508-648-1559 FAX ' TYPE OR OCCUPANCY TYPE COMMRCIALE] EDUCATIONALE] RESIDENTIAL CLEARLY NEW:Q RENOVATION:® REPLACEMENT:0 PLANS SUBMITTED: YES© NOD APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER COOK STOVE Sl ,. ?: I ,I . CONVERSION BURNER r ; _ � . iiiinlitlall. DRYER DIRECT VENT HEATER �� r >� ^- lir .n__..._,��FIREPLACE I _FRYOLATOR1 I [.-. 1 - II ,_ _— FURNACE flSs(aa Ia a ,S GENERATOR ASSC GRILLE Mi i _iI tfes( , INFRARED HEATER — _ r_ I LABORATORY COCKS f - I MAKEUP AIR UNIT OVEN n s POOL HEATER �fS sms _I ROOM ISPACE HEATER 01011011SMOSpialuliSSIMOSSIOrt ROOF TOP UNIT .11(•MISINSINESSaaMm {j_a TEST _S_ �S__s__ais __i . UNIT HEATER HEATERut UNVENTED MHEATER MilaStailmilSOWSIMOIstifiallialISISOSS WATE OTHER I SIMIi f_ IIM� _ _ 0S IIs tn1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES 0 NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY Q 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. CHECK ONE ONLY: OWNER 0 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 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. Ci 0 CV---- 7 PLUMBER-GASFITTER NAME Craig Bishop LICENSE#15101 SIGNATURE MP(B MGF 0 JP E] JGF© LPGI0 CORPORATION©#I 1 PARTNERSHIP p# LLC 17,1# iia COMPANY NAME:�High Efficiency j ADDRESS 378 mute 130 6 CITY !Sandwich j STATE Ma ZIP 02563 jTEL1.____________J FAX! 1 CELL. EMAILIadmin@high.efficlencyllc.com g t tnf b./7 ,,2)/ //47/y