HomeMy WebLinkAboutBLDG-20-001429 r y ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
euf� CITY south yarmouth MA DATE 8/30/2019 PERMIT# OP dZ2—GV/ L
JOBSITE ADDRESS 9 captain smalls rd OWNER'S NAME catherine hutchins
GOWNER ADDRESS TEL 3942574 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO0
APPLIANCES 1 FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER .,1 I
BOOSTER __ _
CONVERSION BURNER I� 11-- �, I U 11 { 11
COOK STOVE _. ..
DIRECT VENT HEATER - _ _ �� I I,
DRYER II -. .1J 1U J) �
FIREPLACE _ i .. 1 1.
FRYOLATOR
FURNACE I - l I
GENERATOR .__ ... -
GRILLE II 1 - . I
INFRARED HEATER j _ . ,- I
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN � I._ :_ -, o 1
POOL HEATER �. I .I I Z ��
_ROOM/SPACE HEATER
ROOF TOP UNIT A J(
TEST I,
UNIT HEATER 1-L_- I
UNVENTED ROOM HEATER
WATER HEATER x 1 .�
OTHER 1. U O U U 1 .
Y - 1 1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY n 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: OWNER 0 AGENT 0
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 an cur a tot o my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli with II rtinent ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 SIGNA E
MP 0 MGF 0 JP 0 JGF❑ LPGI U CORPORATION 0# 3698C PARTNERSHIP 0# LLC 0#
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
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