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HomeMy WebLinkAboutBLDG-17-003226 lY 4,00 1/4, 1 slielzi Apoilinnemi 4 cyii. hi..., — 0,,"- , 4 Lk, AialQ, jink, 776401 i---la ill 03.0. (B 1025, ,8 , Al MA 01775 'a' PERMIT DIG SAFE NUMBER City or Town: Yarmouth Date: 12/19/2016 , Start Date: Permit Number(if applicable) 102016 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: 10 Kingsbury Wy/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 ? I/Ka T • IVIA SSACHUSETTS UNIFORM APPLICATION FOR A. PERMIT TO PERFORM GAS FITTING G WORK j 14 CITY u.,. Por MA DATE l / PERMIT# • JOBSITE ADDRESS u r›. OWNER'S NAME f>c OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALPRINT ©� CLEARLYNEW:❑ RENOVATION: PLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO APPLIANCES 1 FLOORS-4 Bail 1 2 3 4 5 6 7 8 9 10 11 12 '13 114 BOILER BOOSTER CONVERSION BURNER 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 WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES (0 ❑ 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and curate to the best of my Wedge and that all plumbing work and installations performed under the permit issued for this application will be in complian .with I Pertinent pravi ' of the Massachusetts State Plumbing Code and Chapter'142 of the General Laws.14.1 PLUMBER-GASFITTER NAME 6 , j2 _ c_ LICENSE#Ze)9 Z/ S SIGNATURE MP ❑ MGF❑ JP'GF❑ LPGI ❑ CORPORATION ❑# PARTNERSHIP❑# LLC U# COMPANY NAME ADDRESS a0 ec C O%---S ESA, /� C1, CITY /VC--r—tt STATE //•, ��-t ZIP G Z-6 S11.5 TEL Z2'1`" o)"CJ Lf/G I FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES 645 Yes No /' 42° ,k% THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE: $ PERMIT# PLAN REVIEW NOTES 1 1