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Home My WebLink AboutBLDP-18-005384 I1 5' . : o, -,0o A , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -nal,/ CITY W.Yarmouth MA DATE 03/19/18 (PERMIT# P JS'-o06as `/ g 0. JOBSITE ADDRESS 240 South Sea Ave. OWNER'S NAME David Standring GOWNER ADDRESS SAME I TEL 508-958-6814 JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Di PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOQ APPLIANCES 1 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I ,� iI , 1 I � iI I BOOSTER CONVERSION BURNER a itiJf cion" I' I • . �1 111 FRYOLATOR •_ INFRAREDGRILLE .1 LABORATORY COCKS •• III EATER Hi a ROO ACE HEATER RRRIRNRRRR ••• u a •: TEST 1 Il 9 II I l UNIT HEATER UNVENTED ROOM HEATER I , WATER HEATER I i OTHER r ,I I 1 ii I i I I INSURANCE COVERAGE I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES El 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 El 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 = • ac - - to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In corn{: •_ 'th all •ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A i PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHIP 0# LLC❑# COMPANY NAME: South Shore Heating&Cooling, Inc ADDRESS 57 White's Path CITY South Yarmouth 1 STATE MA J ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL 'EMAIL art- si(Agle df -7 vo 9 -rd --)pywdV S. .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK " e CITY W.Yarmouth MA DATE 03/19/18 PERMIT# dia'"i$"�n be JOBSITE ADDRESS 240 South Sea Ave. OWNER'S NAME David Standring OWNER ADDRESS SAME TEL 508-958-6814 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOQ FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB si—arm MONK la Oa Entaliimit Imot CROSS CONNECTION DEVICE 111011,1, - E Mut o moot moo DEDICATED SPECIAL WASTE SYSTEM WM 1111111 MIIII NM MEI.——NMI MIR NS Mt DEDICATED GAS/OIL/SAND SYSTEM on la mil EN NM 1111. IIIIIIII NMI MIN,11111111 11111111( DEDICATED GREASE SYSTEM ::a S SIIIIIIII DEDICATED GRAY WATER SYSTEM IS NMI Ma NEI NS PAWSr w MI MIa MI M DEDICATED WATER RECYCLE SYSTEM ION DISHWASHER —IMN—: -. -. MIS MIN On DRINKING FOUNTAIN •fl- FOOD DISPOSER FLOOR/AREA DRAIN NM MN NMI—.Mtn MIR MINI INNS MO an INTERCEPTOR(INTERIOR) RU.RR� RRRR* UU KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL 111111 111 111111111111111111 1111 SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION ,,1111,1111111111111.-- o WATER HEATER ALL TYPES INS ovum WATER PIPING OTHER 111111 =it ion mei nuMINEI IS PM,IS MS "tip � INSURANCE 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❑, 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 a • acc at; to - •- t of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In comps., w' al •- en • ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4 w PLUMBER'S NAME Keith J.Famham LICENSE# 11601 / SIGNATURE MPO JP❑ CORPORATIONID# 3698C IPARTNERSHIP❑# LLC 0# 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 J EMAIL "(/ // , Sie/A -4/at7 ; ko CV