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HomeMy WebLinkAboutBLDG-19-002785 ae. a AO y 474 08,2,padfflued ,ate, - e - , a ,ate Mamiwi IP.(0. 03 1025 Ra z Lail Alatik, MA 01775 DE. . PERMIT DIG SAFE NUMBER City or Town: Yarmouth Date: 11/06/2018 Start Date: Permit Number(if applicable) 102360 In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted to New England Plumbing For permission to: Unvented Gas Heater Installation 527CMR 1.12.8.6 Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes. Notify YFD before and after work is complete. At: 27 CENTERBOARD LANE /South Yarmouth, MA 02664 Fee Paid $ $50.00 This permit will expire on Signature of Official Granting Permit /L (, Title C 4? / - v C This permit must be conspicuously posted upon the premises MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 14-a-%.WAO CITY So ��.. y � _ hhP, DATE I/ 6 l,� PERMIT /� / JOBSITE ADDRESS �7 �C t e.r"ii(Oc�„r C.�f.L.. OWNERS NAME R Lec Y / - t - OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL©� PRINT CLEARLY NEW: RENOVATION: PLANS SUBMITTED: ❑ � REPLACEP�9ENT: ❑ YES❑ NO ©� APPLIANCES FLOORS-4 6SM 1 2 3 4 5 6 75 9 10 'I'I 12 '13 14 BOILER BOOSTER CONVERSION BURNER, COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE I —� FRYOLATOR FURNACE GENERATOR. GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN lil POOL HEATER ROOM I SPACE HEATER i ROOF TOP UNIT TEST • - /- UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES [1-1Ci ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT j 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 w' all Pertinent provision o' -e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Ij .. � 51,e.r LICENSE# Lo 9 2/ SIGNATURE MP ❑ MGF❑ JP L1V' IGF❑ LPGI ❑ CORPORATION❑#F PARTNERSHIP❑## LLC❑# COMPANY NAME ADDRESS 2C/ I' L°c,_c_v 1- olA, CITY STATE 17A- ZIP 0 6 V�— TEL 72 2,a5-a WC7 FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLYI I1�1Ai INSPECTION11 TE5 'des No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT PLAN REVIEW NOTES l A