HomeMy WebLinkAboutBLDG-2-002564 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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'7 CITY SOUTH YARMOUTH MA DATE 11/1/2019 PERMIT# l 0'(OG.-06
JOBSITE ADDRESS 7 DOVE'S WING RD !OWNER'S NAME 1-PAULA TUANO
OWNER ADDRESS 7 DOVE'S WING 1 TEk(508) 394-0596 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ' 1 RESIDENTIAL Li
PRINT
CLEARLY NEW:( ; RENOVATION:! i REPLACEMENT:E PLANS SUBMITTED: YES LI NOD
APPLIANCES-I FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER �_1 i- -
BOOSTER
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CONVERSION BURNER -1'
C-3" COOK STOVE 0''
DIRECT VENT HEATER I € F(i
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FURNACE IIIIM 7- � I�'� �
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GRILLE rill,- - r!,.!
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GENERATOR
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MAKEUP AIR UNIT r- ;�..INFRARED HEATER _
LABORATORY COCKS maii.....in - i--_. -.,, i t i ,I
POOL HEATER
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ROOM
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ROOF TOP UNIT OMNI 1---1, IMP
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UNIT HEATER —I�
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UNVENTED ROOM HEATER _ MIIM _ ,. Win-1
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WATER HEATER 7 ® = _
OTHER
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
' LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY ri BOND 1 1
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 rj
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 com fence y'th all P rti nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME I_Keith J. Farnham LICENSE#1 11601 GNATURE
MP 0 MGF L1 JP El JGF LPG':1 CORPORATION I'1#1 3698C PARTNERSHIP®# LLC LI#
COMPANY NAME:I South Shore Heating&Cooling, ADDRESS 57 White's Path
CITY 1 South Yarmouth STATE MA ZIP 102664 ___ITEL L508-398-690 i 1
FAX�508-760-2681 CELL' EMAIL info@southshoreheatingcooling.com
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