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HomeMy WebLinkAboutBLDG-18-003538 19,2,paihnvni cy,A,2, , Ala& 776,Acii y` 6'.N. (86,,L 1025, Ala& Lactj)law-, MA 01775 PERMIT DIG SAFE NUMBER City or Town: Yarmouth Date: 12/14/2017 Start Date: Permit Number(if applicable) 102190 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: 8 HOLE IN ONE DRIVE /South Yarmouth, MA 02664 Fee Paid $ $50.00 T permit will expire on Signature of Official Granting Permit Title / 4':1?, This permit must be conspicuously posted upon the premises '' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ter; =;_(s i_ j`7 J :.r�.> CIT`( yc�-r—u,- o �.. MA DATE il�/f��2 PERMIT# 41,-1t`f tie✓. ' •,r`ems-.1 JOBSITE ADDRESS g c )C'. I.t—. C7 v\.Q. OWNERS NAME ,UV.. r L i l !.i vv OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL[ 1-**---- PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ©:------- PLANS SUBMITTED: YES] NO APPLIANCES 1 FLOORS-4 BSM 1 ? 3 4 5 6 7 8 9 10 VI 12 13 1 BOILER —1 BOOSTER CONVERSION BURNER COOK STOVE 11 DIRECT VENT HEATER I DRYER FIREPLACE i FRYOLATOR FURNACE GENERATOR GRILLE ■■■ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM(SPACE HEATER I ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER I_l___ WATER HEATER OTHER I 1 . 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.'I42 YES NO ❑ 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. i CHECK ONE ONLY: OWNER ❑ AGENT ] li J 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 ' all Pertinent prow ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /e- </ PLUMBER-GASFITTER NAME 6/'e-._,_.. p_. 5-L. cr-t.....c—._.. LICENSE#ZG}'Z/ SIGNATURE MP ❑ MGF❑ JP JGF❑ LPGI ❑ CORPORATION ❑# PARTNERSHIP❑# LLC❑#i: COMPANY NAME S ? �j ' lti . - ,��j/ ADORES,, N �`,> 11;A7 e ; CITY fl cd`6✓i �. STATE �t ZIP 0 ZE y� TEL 7' —2 9`0ki, FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES