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HomeMy WebLinkAboutBLDG-19-005019 . 4 s,-., .,_ ... MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Yarmouth Port MA DATE 02/20/19 p PERMIT# Da"/9'-0d`lj JOBSITE ADDRESS 46 Greenland Circle OWNER'S NAME Anthony Darretta ,__3" OWNER ADDRESS SAME_„_„m „_„e�w..................o,,.,. .... ....,. �. �..,_.. . TEL74-994-8509 FAX .... , ., TYPE PE',OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:© REPLACEMENT:] PLANS SUBMITTED: YES 0 NOQ APPLIANCES-1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1,,,,,,,„ .I ___ 7_ 1r- -ii j - ,....�._ I I BOOSTER CONVERSION BURNER .L..__- - -i- J� --7- _I, I COOK STOVE I� 7: '} DIRECT VENT HEATER r...... : DRYER ,f FIREPLACE 1 . FRYOLATOR r FURNACE r I rl t �� GENERATOR __., , Ii ...I 3/41_, t _.. _. GRILLE • .,,., 1. Jr., r-- —ar-i INFRARED HEATER , LABORATORY COCKS _ i MAKEUP AIR UNIT — „_ OVEN _ __ I POOL HEATER r ROOM/SPACE HEATER ' ,,.. ' ��' 1 :_ � _.. _ . . _ . ROOF TOP UNIT TEST J ( _ I UNIT HEATER �,., _ �_ � I'. . UNVENTED ROOM HEATER �1— �( n . WATER HEATER r I i _...... OTHER i IL_......,� j , ,. i -I 1 n.. 1._ ii nHHH -7 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ID NO ID I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY © BOND 13 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 ED 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 a ac r to st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comps" e/ 'ne t pr sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /7, PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 SIGNATURE MP 0 MGF© JP 13 JGF© LPGI L j CORPORATION 0#[ 698C PARTNERSHIP # LC©# COMPANY NAME: South Shore Heatin &Coolin , ADDRESSL57 White's Path CITY LSouth Yarmouth STATE LMA ZIP r02664 JTEL 508-398 6901 • FAX T508-760-2681 i CELL EMAIL ink) 't 7(1I Y_r,P.h/G-r)119(""onif h�__.CUr �\ 1/