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HomeMy WebLinkAboutBLDG-18-003596 414 tfit- ' soIn rnt 4 ,Yv� �8 e ,. , 4 th imah, 3- am is =c...% =-_I tP.N. (86,,L 1025, �8tat, fit, Now-, MA 01775 4 PERMIT DIG SAFE NUMBER City or Town: Yarmouth Date: 12/14/2017 " Start Date: Permit Number(if applicable) 102191 In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted to: Glenn Sherman 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: 72 DRIVING TEE CIRCLE /South Yarmouth, MA 02664 Fee Paid $ $50.00 This permit will expire on Signature of Official Granting Permit Title , This permit must be conspicuously posted upon the premises _9= MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' = 1 �' � MA /) PERMIT# /�G,OU--l1l�00 `�k�. 6 CITY G.:r�,..��,i DATE �� /�/ /2/WtLivG n.?G� c i 1 JOBSITE ADDRESS / �y OWNERS NAME —. C K.40) OWNER ADDRESS ©� O� Aoatvn9' . TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL ❑ RESIDENTIAL©� PRINT T CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: �E ❑ ®� YES❑ NO APPLIANCES 1 FLOORS—I BEM 1 2 3 4 5 6 7 8 9 10 11 12 13 I 14 BOILER BOOSTER CONVERSION BURNER. I 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 � Ce. 7 13 WATER HEATER cal OTHER INSURANCE COVERAGE �� I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL.Ch.142 YES lN'I.Lt ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE B 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 ❑ 1 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 accurat 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 wit Peertinentt provi�si f the Li) Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �.�.. - S L er... LICENSE# SIGNATURE MP ❑ MGF❑ JP JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#i: COMPANY!//( c—�— l c� STATE NAME //�� ADDRESS W ems.C,G�, ��/ Jed. CITY /✓A- ZIP 0 'a,6 V$ TEL 2 ,-• Gv9'o3//c [.,i FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECIOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • •