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Home My WebLink AboutBLDP-19-000414 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK %L CITY YARMOUTH , MA. DATE 7/16/18 PERMIT#,�/q— JOBSITE ADDRESS 71 MELGO LANE OWNER'S NAME HARRINGTON P OWNER ADDRESS: SOUTH YARMOUTH TEL: FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXUTRES 1 FLOORS Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT 0 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 accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com iance with II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER NAME: LEON E CLARK,JR. UCENSE# 11734-M SIGNATURE COMPANY NAME: I TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS:118 ATLANTIC AVENUE CITY:I SOUTH DENNIS I STATE: MA ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL 508-367.1452 EMAIL:I MASTER 0 JOURNEYMAN 0 CORPORATION 0# PARTNERSHIP❑# LLC 0# • (/ g4.0 LMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK v,= IT CITY YARMOUTH , MA. DATE 7116118 PERMIT#friili hall y(Y JOBSITE ADDRESS 71 MELGO LANE I OWNER'S NAME HARRINGTON GOWNER ADDRESS: I SOUTH YARMOUTH TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXUTRES 1 FLOOR-. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM(SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this appli on will be in compliancepl� withwiall Pertinent om provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. e � � PLUMBERJGASFITTER NAME: LEONE CLARK,JR. LICENSE# 11734-M IGNATURE COMPANY NAME: I TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS:118 ATLANTIC AVENUE CITY: I SOUTH DENNIS I STATE: m ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1452 EMAIL: 1 ' MASTER 0 JOURNEYMAN 0 LP INSTALLER 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# Gk� ERR 4 /52 C/C 14 •