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Home My WebLink AboutBLDG-23-000365 q MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ( ,' CITY 'YARMOUTH Ii_ I MA DATE (July 22,2022 'PERMIT# BLDG-23-000365 JOBSITE ADDRESS 1320 NORTH MAIN ST I OWNER'S NAME (WHITE J GRIFFIN G OWNER ADDRESS (WHITE DANIEL 320 NORTH MAIN ST SOUTH YARMOUTH MA 02664 I TEL I TYPE OR OCCUPANCY TYPE PRINT COMMERCIAL IDRESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 FIXTURES FLOORS� PLANS SUBMITTED: YES El NO ID 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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 © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 I LICENSE# 111601 I SIGNATURE MP© MGF 0 JP El JGF 0 LPG' El CORPORATION❑#I I PARTNERSHIP I ❑#I ILLC ❑#I COMPANY NAME: (South Shore Heating&Cooling I ADDRESS. 157 Whites Path, CITY IS Yarmouth 'STATE (MA I ZIP 102664 I TEL 15083986901 FAX I I CELL I I EMAIL I I 1