HomeMy WebLinkAboutBLDG-20-002322 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
®3��:s
�.1i�> CITY S.Yarmouth MA DATE 10115/19 PERMIT# ,G/2G-24o7J
JOBSITE ADDRESS 320 N.Main St. OWNER'S NAME Daniel White
GOWNER ADDRESS SAME TEL 774-208-8160 FAX
TYPE OR OCCUPANCY TYPE COMMERCIALE EDUCATIONAL RESIDENTIAL El
PRINT
CLEARLY NEW:❑ RENOVATION:U REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOE
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER BOOSTER
�'2,I �', '�
CONVERSION BURNER
7� !
COOK STOVE
DIRECT VENT HEATER 111111
DRYER ppm,FIREPLACE
FRYOLAT R-7 FURNACEO �BI�IN�=_
\ GENERATOR
GRILLE
INFRARED HEATER MIMI=II��� � �'�'�
LABORATORY COCKS �MWIII , 'IIIM
• L;ATER
OF TOP UNIT
iIiiiiIIiiIiIiiI
11
TEST
UNIT HEATER II
UNVENTED ROOM HEATER
WATER HEATER
OTHER
1.1111".
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 ❑ OTHER TYPE INDEMNITY ❑ ____ BOND I❑
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 acc ate best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp' ce wi all i?provision e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 SIGNATURE
MP 0 MGF I—] JP❑ JGF U LPG] CORPORATION E# 3698C PARTNERSHIP❑ LLC❑#
COMPANY NAME: South Shore Heating&Cooling, ADDRESS 57 White's Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901
FAX 508-760-2681 CELL EMAIL info@southshoreheatingcooling.com
Graf
sQ) ,