HomeMy WebLinkAboutBLDG-20-002611 UNIT 2E � -3 'J
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
=_hf y CITY West Yarmouth MA DATE 10/28/2019 PERMIT# 'a G"'02 _ ArP/(
JOBSITE ADDRESS 193 Camp St. Unit 2E OWNER'S NAME Davenport Realty
GOWNER ADDRESS 193 Camp St. Unit 2E TEL 508-367-0116 FAX 1
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL El RESIDENTIAL
PRINT
CLEARLY NEW: j RENOVATION: REPLACEMENT:LI PLANS SUBMITTED: YES NO0
APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I .___.I _ !, - 1 iI -
BOOSTER
CONVERSION BURNER )_____ _ _ ', t,�_,.. .,._,_._ 1 ... „_ _.._ a°'' . _..,;,�a,,e_______1L. .__.
COOK STOVE
DIRECT VENT HEATER i I i
DRYER I Ie m_ __, f 1 fJ
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FIREPLACE et I' • .
FRYOLATOR
FURNACE 1 _�. ' �` ; �._
GENERATOR J „
GRILLE 1
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INFRARED HEATER 1
LABORATORY COCKS .
MAKEUP AIR UNIT , i .-_ ! -i ___ _ _ .�_ l
OVEN ;. — _-
POOL HEATER _
ROOM/SPACE HEATER ,�I I e
ROOF TOP UNIT a �_ _.__A
TEST on r . .i______I
UNIT HEATER _I m ___
M ' .1 . Awl +
UNVENTED ROOM HEATER n ow' R . I
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WATER HEATER _
OTHER I __,1„ __ _ ;iI__ _wm — ,
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ) OTHER TYPE INDEMNITY _1 BOND LI
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 ri AGENT Li
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 ccura to est o my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli with•a i nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .1/4'_(�
PLUMBER-GASFITTER NAME Keith J.Farnham 1 LICENSE# 11601 SIGNAT E
MP ED MGF I I JP ri JGF LPGI _I CORPORATION # 3698C j PARTNERSHIP # _ LLC-1#
COMPANY NAME: South Shore Heating&Cooling, J ADDRESS 57 White's Path mm
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901
FAX 508 760 2681 1 CELL EMAIL info@southshoreheatingcooling.com
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