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APPLIGATION FOR PERM!T
01115
City or Town: Yarmouth
Date:07/o8/20L9
permit Number: 102407
ln accordance with the provisions of M.G.L. Chapter 148, as provaded in Section 10 A application is hereby made
by;
Address: South Yarmouth, MA 02664
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For permission to: Unvented Gas Heater lnstallation 527CMR 1.12.8.6
Name of Competent Operator:E.F. Winslow Plumbinq
Date lssued-Rejecled 0l / oa / 2OL9 By
Date of Expiration
(Signature of applicant)
Due
'170
52KE01
Fee: S50.00 $ paid
Cert. No.
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Application for Standard Permit
FP-006
(Rev 1 1 2015)a Retum completed application to:I
Permit Number
City or Town rnK
Date t lal,e
ln accordance with the provisions of l\4.G.L. Chapter 148, as provided in Section
t
application is hereby made
DIG SAFE NUMBER
by
of
(FullName ol Person Film orc
n Ret/r"-, C,r.rlc $6,r*< ga.t\,,,L ,t^,1 o)64f
@ooet
for permission to (state clearly purpose for which permit is requested)
Ha^*'- '
1n<ln l( ()au(nkl .6 K
Name of Competent
Date lssued-rejected
Operator (applicable)
Date of expiration ,r/alta Fee
f*bl Lou u.to cert No (irt93-
9b
(Sqnature or Applican0
Amount Paid $o<)
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FP-006
(Rev. 1.1.2015)PERMIT
Date
ln accordance with the provisions of M.G.L. Chapter 148, as provided in
to
this permit is granted
DIG SAFE NUMBER
(FullName ol PeGon. Fim orCorporalion)
Restrictions
at
(Street and # or Oescnbe Locaton lor Adequsle ldentfcatlon)
Fee Paid $This permit will expire on
Signature of Official Granting Permit Tifle
/o ) 4ot
Start Date.
t
Ch.oa
City or Town:
Permit Number (if applicable):
for
Start Date.
- This permit must be conspicuously posted upon the premises ts