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Home My WebLink AboutBLDP&G-18-001957 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1)aii 6 CITY[south yarmouth MA DATE 9/18/2017 1 PERMIT# P 4g�/95 7 .�a JOBSITE ADDRESS 14 pond st#14 OWNER'S NAME[thomas roche P ---- OWNER ADDRESS[ �_ TEL 247 7913 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL f EDUCATIONAL I I RESIDENTIAL H PRINT CLEARLY NEW:rI RENOVATION:[1 REPLACEMENT:0 PLANS SUBMITTED: YES( I NO[1 _FIXTURES-1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I-I-�1 } ---]---u----ir _CROSS CONNECTION DEVICE I II_ I ..L. 1 )r DEDICATED SPECIAL WASTE SYSTEM 1 _� jI l I' 1l_ I DEDICATED GAS/OIL/SAND SYSTEM _l 1[ 1I _ I it DEDICATED GREASE SYSTEM _ [ I, 1 1l 1P DEDICATED GRAY WATER SYSTEM I 1r n- lr _ -1 DEDICATED WATER RECYCLE SYSTEM • - 1 I DISHWASHER --L__ IL DRINKING FOUNTAIN IL I[ FOOD DISPOSER T 1 _ -1r FLOOR/AREA DRAIN —J'' INTERCEPTOR(INTERIOR) JL 1J _ KITCHEN SINK _. - 11- I LAVATORY -1- j - IL ROOF DRAIN SHOWER STALL I II l[ „ SERVICE/MOP SINK i i {ri[- _ i- J — TOILET — ��-_�!----1[ I I 1 — 1 URINAL I � I�_--IL --II-- WASHING MACHINE CONNECTION -IL ^�[ 'l WATER HEATER ALL TYPES I x j _ I - WATER PIPING [ , L '- � OT- I Imm, I! `1L — I( If— 11 Ir.--1. !! 1 . _ --7- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES , NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY[i] OTHER TYPE OF INDEMNITY 0 BOND [I 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 I AGENT Li 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 and a curat best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp. ce ith Pertinent p ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Famham _ 'LICENSE# 11601 SIGNATURE MPL] JP LJ CORPORATION 3698C IPARTNERSHIPI # 1LLC❑# i COMPANY NAME I South Shore Heating&Cooling,Inc. I ADDRESS 57 Whites Path CITY South Yarmouth 'STATE MA ZIP r0T64 _ j TEL 508-398-6901 FAX 508-760-2681 CELL I I EMAIL - -. .411-/\i,)d 4'3C' "---- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 5 mieffwt1=,y CITY I south yarmouth 1 MA DATE 9/18/2017 PERMIT# / -0/P"/1''OOJ957 JOBSITE ADDRESS r14 pond st#14 OWNER'S NAME [thomas roche I GOWNER ADDRESS ---- __ I TE 247-7913 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL] EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:L] RENOVATION:L] REPLACEMENT:[_j PLANS SUBMITTED: YES El NOD APPLIANCES- FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER r-- j. I_. 1 BOOSTER - . --,-- 1 ;_ — CONVERSION BURNER 1 — COOK STOVE DIRECT VENT HEATER I- _ f I DRYER - FIREPLACE l' 1i ►. FRYOLATOR ._ -- - „ '!---_ it — FURNACE F I ( ; GRILLE ENERATOR I — I � _ INFRARED HEATER _ I i _ r: LABORATORY COCKS �—_ .. _r _ MAKEUP AIR UNIT — _ '� !( ] _ OVEN _ 1- POOL HEATER L'� -1 . ROOM/SPACE HEATER -___Jr, _ 1[ i ROOF TOP UNIT , j IT v TEST IL I UNIT HEATER T _ A) _ I UNVENTED ROOM HEATER OTHER f -i�.__ r 'j -W-{ 1 -i-J li WATER HEATER f x -w� ,� I ,. in — I _ r.,....___ _ _ - --1 ... .,, 1. .: INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 'NO '1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Li OTHER TYPE INDEMNITY l j BOND 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 L___j AGENT L.i 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 cur b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp!' e i a Pertinen provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 1 Keith J. Famham LICENSE#r11601- ] SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPG!Ei CORPORATION E# 3698C I PARTNERSHIP❑# LLC❑#r_ -1 COMPANY NAME: South Shore Heating&Cooling,Inc ADDRESS 57 White's Path __ I CITY South Yarmouth I STATE MA ZIP 02664 TEL 508-398-6901 FAX[508-760-2681 CELL EMAIL] I