HomeMy WebLinkAboutBLDP-19-005413 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
43--7r CITY Yarmouth Port MA DATE 3/19/19 PERMIT# A--PP`/j—OO 5-9_/3
JOBSITE ADDRESS 148 Kate's Path OWNER'S NAME Barbara Wingardner
GOWNER ADDRESS SAME J TEL 774-330-3920 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ID
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CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:I] PLANS SUBMITTED: YES NOD
APPLIANCES 1 FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 I 13 14
BOILER I I
BOOSTER .'I 11 1 I li 1 f II
CONVERSION BURNER ILL
COOK STOVE 1
DIRECT VENT HEATER J 1 J t
DRYER i_,_ _ -._ , r w. 9,4 FIREPLACE I El
FRYOLATOR I
FURNACE 'I -. i
GENERATOR
GRILLE ( - U 11
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT 11 __ I . 1 JJ
OVEN _ e - _ _ . I' ..,,_ U
POOL HEATER ' ` 1
ROOM/SPACE HEATER J U f L I)
ROOF TOP UNIT I , iL 0
TEST
UNIT HEATER J .. _ 'I U U
UNVENTED ROOM HEATER L__. ! 11, I
! U
WATER HEATER 1 I 1I E
OTHER 1 U U 11
U
1 I o
I i� I 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 ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ 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 ❑ 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 an ur to t e best of y knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compl' wit Pe pro ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 SIGNATURE
MP❑ MGF❑ JP 0 JGF❑ LPG!0 CORPORATION Q# 3698C PARTNERSHIP❑# LC❑#
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
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