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Home My WebLink AboutBLDP-18-005385 TO c\ '• 1 (o'O .-c-.) . - . ,,„80.00 6 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Vila CITY W.Yarmouth MA DATE 03/19/18 I PERMIT# b&A"/t a,, gs" JOBSITE ADDRESS 242 South Sea Ave. OWNER'S NAME David Standring 1 GOWNER ADDRESS SAME TEL 508-958-6814 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL ID PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD APPLIANCES 7 FLOORS-. BSM 1 2 3 4 56 7 8 9 10 11 12 13 14 BOILER -1i ( E ' I a 1 1 1 1 BOOSTER III r it CONVERSION BURNER COOK STOVE r i I r1,14 DDIRECT RYER VENT HEATER 11111.1.1111111 1 1111111111111111 FIREPLACE ItJ linglF,IIt LFRYOIATOR , ' FURNACE M!MIN!/11WWWWW. 171-6 UMW GENERATOR GRILLE INFRARED HEATER oppopppg ppiippil LABORATORY COCKS OVENUP AIR UNIT gpappeppi ;ppm!11 POOL HEATER ROOM/SPACE HEATER i ROOF TOP UNIT n Mi WI. TEST UNIT HEATER i i i I op 1 11 111 1 pori iit , UNVENTED ROOM HEATERp 1 , . WATER HEATER ;0141 .. !ppm, d ,R OTHERit IR r- '— 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 0 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 an- accur to -t , = - my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In comply wit all ---i ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - e , PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE# 11601 SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION D# 3698C PARTNERSHIP❑# LLC❑# COMPANY NAME: South Shore Heating&Cooling, Inc ADDRESS 57 White's Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL �, L _* alx -tart it: , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _1 _3t CITY W.Yarmouth MA DATE 03119/18 PERMIT# 4440friet110 SSC JOBSITE ADDRESS 242 South Sea Ave. OWNER'S NAME David Standring POWNER ADDRESS SAME TEL 508-958-6814 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NO❑+ FIXTURES 1 FLOOR–. BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 r pp BATHTUB II 9 ( I 1 1 _[ f { CROSS CONNECTION DEVICE ,I—� (— DEDICATED SPECIAL WASTE SYSTEM ,J, { DEDICATED GAS/OIUSAND SYSTEM il soissi, DEDICATED GREASE SYSTEM L ; II- a �1 0 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM tI II � DISHWASHER f il— Nrn{ II DRINKING FOUNTAIN L____ j{ T FOOD DISPOSER FLOOR/AREA DRAIN 4 ,1 _ d I I d M i i 1 .1 INTERCEPTOR INTERIOR) kJ, { KITCHEN SINK LAVATORY 4 ROOF DRAIN {L J 4 I- 1 J ,f--,f-- ` SHOWER STALL SERVICE/MOP SINK U • TOILET I I• I t 'I l URINAL .1 1 '1 11 WASHING MACHINE CONNECTION - 1 J_ J d. WATER HEATER ALL TYPES 1 ,1 , , 1 1 i WATER PIPING tl '1 1 OTHER �1 — I-��—� � I r illirINSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF 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 accu t e e of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in comp' ce wi all rt' pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME Keith J.Famham LICENSE# 11601 i SIGNATURE MPD JP CORPORATION D# 3698C PARTNERSHIP 0# LLC❑# COMPANY NAME South Shore Heating&Cooling,Inc. ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL athi- -2r�� 7 -11Y-1 �-2 cy .9