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Home My WebLink AboutBLDP-19-000962 _ xl f • .--. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -'gift:— . rei Ayr.i9 i- n r-f CITY South Yarmouth MA DATE 08/17/2018 PERMIT# P/Q feri962 JOBSITE ADDRESS 16 Eldridge Road OWNER'S NAME Fred Sieland POWNER ADDRESS 184 Mountain Road-Pleasantville,NY 10570 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES 0 NOQ FIXTURES 1 FLOOR-4 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB II -{ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM ' .- . _ _ - - _- DEDICATED GREASE SYSTEM I .- DEDICATED GRAY WATER SYSTEM i _ , ._ _ Ii it _ ,i DEDICATED WATER RECYCLE SYSTEM - - DISHWASHER -- - ......... - DRINKING FOUNTAIN 't . - „ . FOOD DISPOSER I ., i ' i , FLOOR/AREA DRAIN i I\9 '! i I i . INTERCEPTOR(INTERIOR) \ n _ _ KITCHEN SINK I , i A'i- a II _ LAVATORY I ” `� ` ' IL, '1 _ ROOF DRAIN I() '4 ii _ " SHOWER STALL i 1 r r •<`• I c -1i _ .. I " SERVICE/MOP SINK ' ,., _J= f I TOILET l'--- " -1 - � I URINAL WASHING MACHINE CONNECTION m I WATER HEATER ALL TYPES -1 o � WATER PIPING OTHER r - , r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY Q 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 ❑ 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / S Aad PLUMBER'S NAME Tygue S Reed LICENSE# 15200 O SIGNATURE MP El JP CORPORATION D# PARTNERSHIPO# LLCQ# 4047C COMPANY NAME Coastal Mechanical ADDRESS 299 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX 508-760-5800 CELL 508-246-9959 EMAIL lisa@coastalphc.com ‘,eti Lib IV z_gp • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • ,eara o—ne a°6TH' CITY South Yarmouth MA DATE 08/17/2018 PERMIT#t0P-R-17to2 JOBSITE ADDRESS 16 Eldridge Road OWNER'S NAME Fred Sieland OWNER ADDRESS 184 Mountain Road-Pleasantville,NY 10570 TEL /FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NOD APPLIANCES 1 FLOORS-, BSM 1 2 3 4 t 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER • CONVERSION BURNER COOK STOVE DIRECT VENT HEATER � .. . -_ . DRYER FIREPLACE FRYOLATOR LIr i ' 1y r r r , _I FURNACE ,� GENERATOR r . - GEl l � NFRARED HEATER /LABORATORY COCKS L' ' _ MAKEUP AIR UNIT V cr )-Ll'; OVEN L4! V POOL HEATER ROOM I SPACE HEATER? d Q ROOF TOP UNIT TEST UNIT HEATER I UNVENTED ROOM HEATER WATER HEATER OTHER r !R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑l OTHER TYPE INDEMNITY ❑ 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 ❑ AGENT ❑ 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �yA� S And PLUMBER-GASFITTER NAME Tygue S Reed LICENSE#F5-2-05-1 u- SIGNATURE MP Q MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION D# PARTNERSHIP❑# LLC Q# 4047C COMPANY NAME: Coastal Mechanical ADDRESS 299 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX 508-760-5800 CELL 508-246-9959 EMAIL lisa@coastalphc.com a „k° � I FW- 0p}� DSC /1-4 L,rfic 7/fir//r 6 GL- 1,g74