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APPLICATION FOR PERMIT
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City or Town:
Date:
Yarmouth
\2/t2/2072
Permit Number: 101205
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Addressr 88 Benjamin Wy /South Yarmouth, MA 02664
For permission to: Unvented Gas Heater lnstallation 527CMR30:04
Name of Competent Operato r: Tom Keeney
Date lssued-Rejecled !2 / L2 / 20L2 By
Date of Expiration. oL/L2/2oL3 Fee: $s0'00 $Paid
Cert. No.
FEnature ofapplicanlf
Due
137
BENJO2
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application is hereby made
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APPLICATION FOR PERMIT
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FP6 (rev.3/00)
Cily or Town
Dare / l'Lt
ln accordance with the provisions of M.G.L. Chapter 14g, as provided in Section
by
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Address
Sneet o. P.O.8ox)
For permission to (stale clearl ose for which permil is requested
*,u z)l*t /U r4
nama ol peson. Firm at
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V OUTDJ L
A/Fz-.o+r
Name ol competent operator (lf Applicable)
( 1r'j^ttt -h{Ce(. No.
Date lssued-rejected By
OIG SAFE NUMBER
Start Dale
( Signatu.e ol Applicant)
Dale of expiration Fee $ Paid Due
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PERMIT
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D ale
Permit Number (if applicable)
ln accordance with the provisions of M.G.L. Chaple|t49, as provided in
lo
this permit is granted
DIG SAFE NUMBER
Starl Dale
(Fullname ol pe.son, Fim ot Coeoraton)
lor
Reslrictions
al
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(6ive local@n by st.eer ahd no - ot desctibe io such mannet as to ptovide adequala tdantitication ot l;anon)
Fee Paid $
-
This permit will expire on
Signalure ol Ollicial Granting permit Tifle
D rnis permit must be conspicuousry posted upon the premises !
City or Town
,
.\cceptcd PlLrmbing Products Onlinc Svsrcm bv Massachusetts Board ofRegistration ofP... Pagc I ol )
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ine Ofiorai w0Es,le c, !he Oflice ol CorsL/fler Afra rs snd Eusrness Regululon iOCABR)
Division of Professional Licensure
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EURNIR LARGI 116 IO
MANUFACTURER A4OO E L AEC(PTtO EXPIRES CODE
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