HomeMy WebLinkAboutBLDG-16-007156 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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:,tl NI_ J CITY South Yarmouth MA DATE 06/27/2016 PERMIT#Nal./ 'i
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JOBSITE ADDRESS 11 Carol Road OWNER'S NAME Cody Farrier
GOWNER ADDRESS 11 Carol Road TEL 1FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL[3 EDUCATIONAL❑ RESIDENTIALU
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑+
APPLIANCES 7 FLOORS-' I BSM 1 2 3 4 1 5 6 7 8 9 10 11 12 13 14
BOILER _ �I�
BOOSTER r
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CONVERSION BURNER � -1 4 r -
COOK STOVE 1 r i
DIRECT VENT HEATER ,7 i r f 'II --
-- DRYER ---- - --
FIREPLACEI
FRYOLATOR i
FURNACEI , d- i'
GENERATOR 1
GRILLE
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INFRARED HEATER '_ -- -
-, fI, _:ii j
LABORATORY COCKS
MAKEUP AIR UNIT ;- _ r -i � T 'r - ,f
OVEN ;; __ l; f- .r - r -POOL HEATER
ROOM/SPACEHEATER -
ROOF TOP UNIT 211l_ r
TEST _. :..
UNIT HEATER j � A I t , [^ i_
UNVENTED ROOM HEATER e I i f
WATER HEATER i
OTHER iir 1 _
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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 0 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 0 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: OW : ❑ 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 -✓a! ;p.the best of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be in complia,•• # 'rertinent provi '•• • +T:
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //��
PLUMBER-GASFITTER NAME Phillip Durfee LICENSE# 13774 ' SIGNATURE
MP 0 MGF❑ JP❑ JGF❑ LPG/p CORPORATION❑# PARTNERSHIP❑# LLC 0# 3152
COMPANY NAME: Durfee Plumbing&Heating LLC ADDRESS 2A Huntington Ave.
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-619-3078
FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;joy@durfeeplumbing.com
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