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HomeMy WebLinkAboutBLDG-20-001142 $.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ;w r f,t? CITY south yarmouth MA DATE 8/21/2019 PERMIT#4441J -4!3'00 NA, JOBSITE ADDRESS 163 captain noyes rd OWNER'S NAME raymond navarro GOWNER ADDRESS TEL 3942933 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL ❑ RESIDENTIAL ED PRINT CLEARLY NEW:O RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES NOLJ APPLIANCES- FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I U U 0 I U 11 1 BOOSTER 1 J 11 1 1 U U , 1 CONVERSION i COOK STOVE BURNER J [ j1 i. DIRECT VENT HEATER I U U f r t FIREPLACE - ; � I Ili DRYER FRYOLA T OR I Ii U U I U I U 1 U. U FURNACE I x , U U U 1 U11 GENERATOR [ UI U I U GRILLE I U U U 11 U Ii INFRARED HEATER I I 11U U U U J (I LABORATORY COCKS . I II, U ii 11 U L 1 0 MAKEUP AIR UNIT U j U U U U U OVEN I U U ,1 U U U JI U 11 POOL HEATER I( 1 U U U U ROOM/SPACE HEATER U U 11 II ROOF TOP UNIT U U U U 1 V U TEST it I 11 U UNIT HEATER 11 11 11 II UNVENTED ROOM HEATER U U 1 U t I WATER HEATER J U $ 1 j U OTHER j ii, U U L J 1J I 1 I I U U 1 U i 1 1 11 J 1 11 I II 1 1 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABI UTY INSURANCE POLICY OTHER?YPE INDEMNITY {_,f BON { 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 Q 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 a d cc a st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' c wi II ertin provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 SIGNAT MP D MGF JP Li JGF[J LPGI❑ CORPORATION Q# 3698C PARTNERS P❑# 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 Aeeht O �-