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HomeMy WebLinkAboutBLDG-17-006459 MASSACHUStf I S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - 4 cry South Yarmouth MA DAB 6/6/17 PERMIT#4-/�c�/7-41 -v JOBsrTEADDREss 12 Dayton Road OWNER'S NAME Kyle Hein GOWNER ADDRESS same TEL 774-313-7078 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENT IALf PRINT —/ CLEARLY NEW El RENOVATION_❑ REPLACEMBIT:!K' PLANS SUBMI I I Ex YES❑ NO APPLIANCES 7. FLOORS-- sal i 0 © ©2 © 6 =Mx 9 10 _11 12 13 14 BOILER BOOSTER 111111111-1111111.1-__-111101 CONVERSION BURNER 1111111___11111111111_11111111111 ' COOK STOVE IIIMIIIIIIIIIIMNIIIIIIIIIIIIIIIIIOIMIIIIIIIIIIII NM DIRECT VENT HEATER 111111i111.1111111111111110111s11111IMI' 11.1 DRYER _111.1.11.111111-.1.1111._111. ' MI FIREPLACE 111111111111111111111111.11111.11111111111111111111111111111111111111111111111111111111111111111 k FRYOLATOR IIIEIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIMIIN _ FURNACE Inmmommummommmiminim GENERATOR IIMIIIMIIIIIIIIIIIIIIMIIMIIIIIIIIIMIIIIIIIMIIIIIIIIIIMIMMMIIIIIIII GRILLE ,__1111111_______ _ INFRARED HEATER ___111111111111_111111_i NM LABORATORY COCKSi_111111_11.11__' MI MAKEUP AIR UNIT __i1111li MN OVEN �_!_ M _ N__ Ij(N POOL HEATER IIIIIMIIIIMIIHIIIMINIMIIIIIIUIIIIIMIIIIIIIIIIIIMIIIIIMIIIIIIIIIIIIIIIIIII ROOM!SPACE NEATER 11111111111111111111111111111•1111111.11111111111111111 ROOF TOP UNIT 111111111111111111M1111111111111111111111111111111111111111111111169111.11.1510 TEST 11111111111___ ; �0�� UNIT HEATER -_____111111111111•_ _ UNVENTED ROOM HEATER - - _ J,1-4, !Zl11111111111111.111111111111 _ WATER HEATER E/A���.►'r�VI:P.;,;.��i 0111111111•11 OTHER _____ ____ M. _ IIIMMIEMEr1111111111111111111111111M1111111111111111M111. NIMIIIIIIIIIIIIIIUIIIIIIIIIIIIIIIIIIIIIINHIIIIIIIIIIIIIIIIIIIIIIIII INSURANCE COVERAGE l have a current liability insurance policy or tts substantial equivalent which meets the requirements of MGL Ch.142 YES 2110 ❑ DP YOU CHECKED YES,PI FFGE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d 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 naives this requirement CHECK ONE ONLY: OWNER❑ AGENT Q SIGNATURE OF OWNER OR AGENT 1 I hereby certify that all of the details and rtifamaiion I have submitted or entered regardng this apt pver on are Side and accurate to the b ea ti owledge and that all pluritang work and ions performed underthe pemit issued farthis appra.�m,r will be"m Rance all Pertinent proinuonp- IMassat+usetts State Plumbing Code and Chapter 142 of the GeneraF Laws. / PLUMBER-GASF TTER.NAME ' %y P LICENSE* 1-6 10 r I SIGNATURE I MP✓ MGF❑ JP 0 JGF❑ LPG!0 CORPORATION❑# 2 PARTNERSHIP❑# �LLC❑# COMPANY NAME 1 o t— -Pi-6e c\CU ADDRESS 17 1� * h 'lo(r e )?C) CITY Suncit'ADiCh STATE Mk ZIP o9,5(o3 TEL 5_1l ' `625- * FAX CFI AIL I EMU nit j&\l.C,t Y\- to/t 7 ie ((C. CO m !'Y\Ciatirn- PO- -60x lam{ ortstdcke- '1U1,A. 031044f- OISet /-,k) II