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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
|t/29/2Or3
Permit Number: 101391
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by lZ c., lct,to
Addressr Southrfa+mouth, I/tAJ25r5r'01 o )
Name of Competent Operator:Matthew Colon 774-238-9952
Date lssued-Reiecrcd fL/29 / 20]-3 By
Date of Expiration: O2/2e/2014 Fee: s50'00 $Paid
Cert. No.
142
ARROO4
nature a
Due
For permission to. Unvented Gas Heater lnstallation 527CMR30:04
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City or Town:
Date:
Yarmouth
t7 / 29 /2Ot3
permit Number: '101391
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: South Yarmouth, MA 02664
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Af iil*ffu.,
For permission tor Unvented Gas Heater lnstallation 527CMR30:04
Name of Competent Operator:Matthew Colon 774-238-9952
Date lssued-Re.lecled Lr / 29 / 2OL3 By
Date of Expiration: 02/28/2OL4 Fee: S50.00 $paid
Cert, No.
(Signature of applicant)
Due
142
ARROO4
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PERMIT
City or Town: Yarmouth
Date:LL/ 29 / 2OL3
Permit Number (if applicable)
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section '10 A this permit is granted
to: Matthew Colon 774-238-9952
For permission to: Unvented Gas Heater lnstallation 527cMR30:04
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
DIG SAFE NUMBER
Start Date:
$50.00Fee Paid S This permit will expire on 0212812014
Signature of Official Granting Permit Title
This rmit must be cons icuousl posted u n the rem rses
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