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PERMIT
DIG SAFE NUMBER
City or Town: Yarmouth
Date: 06/12/2017
Start Date:
Permit Number(if applicable) 102085
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: South Yarmouth, MA 02664
Fee Paid $ $50.oo T p rmit will expire on
Signature of Official Granting Permit rTitle /114e9
This permit ust be conspicuously posted upon the premises
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
t iAri CITY X-C-v.wcu,A4-- PO t; MA DATE 5///fit: PERMIT# e 6—00 5v4
JOBSITE ADDRESS t? f�O Q�'Q` L+--• OWNERS NAME g c-r 3
OWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION: V REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO
APPLIANCES 1 FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT � —
/OVEN411'
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POOL HEATER
ROOM;SPACE HEATER
ROOF TOP UNIT
TEST I
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 140
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1117 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 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 #1'all Pertinent provisi of the
Massachusetts State Plumbing Code liand Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME 5 LICENSE#Z09 4 SIG ATURE
MP❑ MGF❑ JP 11-<;GF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# Lc #
? .L�COMPANY NAME ADDRESS ,C7 C,U a,�5 F0!! �£d �f
CITY -(�w�c.�.- STATEIZA ZIP 0 2 6 Y TEL 72 7"'�GP---o w/ l
FAX CELL EMAIL
L��
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