HomeMy WebLinkAboutBLDG-17-000601 N.
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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`��" _? CITY South Yarmouth MA DATEL07128/2016 PERMIT�k� b&-I / OM 6C'J
JOBSITE ADDRESS 6 Bellview Ave 'OWNER'S NAME [Joanne Campbell
OWNER ADDRESS 6 Bellview Ave 4 TEL 05 87834107 'FAX 1
TYPE OR OCCUPANCY TYPE COMMERCIAL T EDUCATIONAL RESIDENTIAL El
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CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES
NO
APPLIANCES Z FLOORS—• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER IMO Mil iii111111111111111 11111��_�_
BOOSTER MIN.1111111111111111111111111111111111111111111111111----_
CONVERSION BURNER Iwi =r__ _—M111
COOK STOVE 1111511111111111111111111111 EN____111111111111111111
DIRECT VENT HEATER IIIIIINIB all NM
DRYER nil INN 11111�_��
FIREPLACE 11111 1—®11111
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FRYOLATOR 1/___,
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER OM MI 1111 -'___
ROOF TOP UNIT 11111__®____
TEST =MBE UNIT HEATER _
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UNVENTED ROOM HEATER �___ 1�_—_____ _
WATER HEATER all Mill ___ _
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L.NO L_.
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i 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: W 1 AGENT D
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 an cc the best of my wledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia rtinent pr ' on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Phillip Durfee LICENSE# 13774 SIGNATURE
MP i MGF rj JP U JGF Li LPGI L i CORPORATION Fl#? 1 PARTNERSHI # _ j LLC i!]# 3152 1
COMPANY NAME:I Durfee Plumbing&Heating LLC ADDRESS 2A Huntington Ave.
CITY I.§outh Yarmouth STATE MA 1ZIPL02664 JTEL 508-619-3078
FAX,508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplunpirorrOy@durfeeplumbing.com
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