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HomeMy WebLinkAboutBLDG-22-005378 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • �'—ire CITY 'YARMOUTH I MA DATE (March 25,2022 I PERMIT# BLDG-22-005378 JOBSITE ADDRESS 135 PAINE RD I OWNER'S NAME MCKENNA ANN MARIE G OWNER ADDRESS 35 PAINE RD SOUTH YARMOUTH MA 02664-2214 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: © RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO El FIXTURES FLOORS—c 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 I 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 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY 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. 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❑ JGF❑ LPG( ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Souh Shore Heating 8 Cooling ADDRESS. 57 Whites Path, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083986901 FAX CELL EMAIL S310N M3IA321 NVid #IMWb3d $ :33J ❑ ❑ 1I 4 J d 3H1 SV S3A2i3S NOLLV011ddd SIHI ON SOA S310N N01103dSNI 1VNId AINO 3Sfl H0103dSNI 2103 39Vd SIH1 S310N NOI103dSNI SVD HOl0d