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APPLICATION FOR PERMIT
City or Town:
Oate:
permit Number: 101420
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
!2/26/2013
For permission to: Unvented Gas Heater lnstallation 527CMR30:04
Name of Competent Operato r: 83 Capt. Bacon Glen Sherman
Date lssued-Rejected L2/ 26/ 20L3 By
Date of Expiration. 02/26/zot4
Cert. No.
(SEaalure ofappliantl
Due
142
oAPT400045
Fee: SsO.00 $ paid
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