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HomeMy WebLinkAboutBLDG-15-002433 2Zi y ,r_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .� "= t `:>t:r_ : CI I Yarmouth , MA. DATE o - -nil. PERMIT#J P4 /S'CCV JOBSITE ADDRESS �_ys� G OWNER'S NAME OWNER ADDRESS % , �. TYPE OR �= ..cur. ': ' f" FAX (��, pR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIO • el --- � 0 CLEARLY NEW 0 RENOVATION:0 REPLACEMENT:fr RESIDENTIAL T PLANS NS S IAL FIXUTRES 1 FLOOR-. Bsmt SUBMITTED; YES 0 NO t BOILER fl©f n 6 la 8 9 10 laill® 13 BOOSTER _� _ilt�' e��_______��KM _ CONVERSION BURNER ��______ ��____ COOK STOVE MIN Mal le DIRECT VENT HEATER ___ DRYER _�� _��_�_�_��_____�_� In IMMEMIlliamaFRYOLATOR -- __ Sling GENERATOR _������__ �r_ IIIIII Int MO MI EnErj2LABORATORY COCKS ____111101 MINIS ====_ IIIII IleSIB Mill Mil �_� Ilin POOL NEATER _S—____ _____ ROOM/SPACE HEATER ______ __a—___ ROOF TOP UNIT _-_____ _____ �INNMil��■■���III. . =_r UNVENTED ROOM HEATER _ _______ __ — Ell — - _ .. 1 _M_ aminiam. MI I have a current is il' insurance policy or its substantial INSURANCE which COVERAGE " • equivalentmeets the requirements of MGL.Ch. 42 i----YES 810 U you have checked yam,please indicate the type of coverage by checkingthe N o PWopdaleboxbelow. OCT 30 214 LIABILITY INSURANCE POUCY OTHER TYPE INDEMNITY 0 BOND, OWOWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverager O f v sER'SI mySsRANCElLaws,andamti •"OJ'!_sz " ' signature on this permit application w�this requiren required by ChapteFT4Z of the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 0 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 Instaitatfons 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. PLUMBEWGASFRMINN .TER NAME: LICENSE#�:r= yI NRTURE '` ' COMPANY NAME i mm u .� ADDRESS: t aintramil CITY: Irt , STATE gait LP: O 6 an j FAX: d'-T95,(, TEL:iLarc,,_�3y,r-.38•YC J CELL: . t.. a.. EMAIL IMINZEINManorarais MASTER IFS JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0#_PARTNERSHIP 0#C7 LLC 0#1 I tg/i