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HomeMy WebLinkAboutBLDP-23-001858 t 1`w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' �� CITY YARMOUTH MA DATE October 07,2022 PERMIT# BLDP-23-001858 JOBSITE ADDRESS 63 KATES PATH VILLAGE OWNER'S NAME BURKE MARGARET A G OWNER ADDRESS 63 KATES PATH YARMOUTH PORT MA 02675 144 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO • FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY❑ BOND ❑ 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. 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 and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith Farnham LICENSE# 11601 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: South Shore Heating Cooling ADDRESS. 57 Whites Path, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083986901 FAX CELL EMAIL I iIV113 I 1130 XVd I I I L06986E805I 131 I b99Z0I dIZ I VWI 31VJS I ylnowJe k ylnoSl AllO filed s03I4M L9I SS380aV I 6ugoo0 6ugeaH aIo4S 41noSI 3WVN ANVd1100 I I #❑ 011 I I #❑ dIHS213N.1 Vd I I #❑ NOI1V1:10d2100 ❑ df © dW 321f11VN01S I L091#lEISN30I1 weywed 411eNI 3WVN S,2139Wf11d •smel leAeueo ay;;o Zq;Ja;dey0 pue epo0 6ulgwnld ems suasnyoessew ay;jo uolslnoJd;uaulped pe y;lm eouelldwoo ul eq!pm uogeolldde sly;jo;penes!puled ay;Jepun pawJoped suogelie;sul pue)laom 6wgwnld pe ley;pue e6pelmoux Aw;o;seq ay;o;eieJnooe pue en.q eie uogeolldde sly;6ulpae6ej peio ue ao peulwgns emu!uogeWJo;ul pue slle;ep ay;;o lie leyl/Woo Agway IN3OV 210 ZI3NMO dO 3 Jf11VNOIS luawannbai slyl sanluM uogeolldde iluuad sly;uo amleu6ls Aw pue'sMel leleue0 suasnyoesseW ayl Jo al,ialde40 Aq pannbal a6eJan0o aoueJnsul ay;any jou saop aasuaoll 0401e10 wen we I:213AIVM 30NV2Jf1SNI S,213NMO ❑ON08 ❑AllNIN3aNI dO 3dAl.83H10 ❑AOIlOd 30NN21f1SNI A11119VI1 M0138 XOS 31VI21d02IddV 3H19NIN33HO A8 3OV2I3AOO dO 3dAl 3H131VOI0Nl 3S1/31d'S3A 03)103HO f10A Al ❑ ON ❑S3A 'ZVL'4319W 10 sluawaafnbej ay;s;aew yolyM lualenlnbe lel;ue;sgns s;I Jo Aollod eouemsuf lllgelf luaJma a amyl :3eV213A00 33NV21f1SNI :N0I1d12i0S3a 2i3H1O 2i3H1O ONIdld 2i31VM 2131V3H 2i31VM NO11O3NNOO 3NIHOVW ONIHSVM 1VNI2ifl 131101 >INIS d011\1/301A2d3S 11VIS 2i3MOHS NIV2ia dOO8 A2iO1VAV1 NNIS N3H01IN (2IO1831NI)2iO1d302131NI NIV2ia V32JV/NOOld 2d3S0dSIa 0OOd NIVINflOd ONINNRia 2i3HSVMHSIa 31SAS 310AO321 2d31VM a31V3Ia3a W31SAS 2l31VM AV2i9 a3_V01030 1/S131SAS 3SVM:19 a31VOIa3a W31SAS aNVS/llO/SVO 031V0103a 1,431SAS 3ISVM 1VI03dS 031V0103a 301A30 NOIIO3NNOO SSO2i0 ❑ON 0S3A :03111W8f1S SNVId /1 : •• _ ©:1N3W30V1d32i ❑:NOIIVAON321 ❑ :M3N Al2iy31O ❑ 1VI1N301S321 ❑ 1V102131410100 _Maid 3dAl AONVdf1000 2iO 3dAl 131 bbL 9L9Z0 VW'121Od HIVd S311:0I£9 SS32100V 213NM0 d • 31AVN S 2i3NMO 30V111A H1Vd S3IV>r E9 858L00-EZ-d019 #11W2i3d SS32100V 311S80f L ZZ/L/OL 31V0 VW )121OM ON18Wf11d INNOdH3d O111W213d V 2iOd NO11y011ddV W2IOdINf1 S113Sf1H3VSSyWOWaV.I �1110 �%