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Home My WebLink AboutP-18-6872 4_... , % to 6- ' �o c.... MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK °}Yia CITY west yarmouth MA DATE 5/21/2018 PERMIT#/4f'J o72 JOBSITE ADDRESS 65 beach rd OWNER'S NAME robin tlasek GOWNER ADDRESS TEL 7817526360 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ APPLIANCES 1 FLOORS-, BSM 1 2 ' 3 ' 4 5 6 7 8 9 II 10 11 12 13 14 BOILER 1 t IJ BOOSTER 1-7)—f- if CONVERSION BURNER F F 1 n L 1 1 J COOK STOVE • 1 L - _ DIRECT VENT HEATER di i , _, DRYER �— ( J FIREPLACE f l II___ FRYOLATOR I r [ t T 4 II FURNACE f GENERATOR GRILLE � � !< � � � ) — j INFRARED HEATERl J J i LABORATORY COCKS F- { r J MAKEUP AIR UNIT _� OVEN POOL HEATER H r c ROOM/SPACE HEATER ROOF TOP UNIT - -, 1J TEST J 7 UNIT HEATER r [ _ UNVENTED ROOM HEATER r J WATER HEATER xf OTHER - - - - — * - I I I I I r I • 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 ❑+ 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 ❑ 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, d a ural a es f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com nce th anent vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Famham LICENSE#F1111-1 SIGNATURE: • MP El MGF 0 JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHIP❑# LLC❑# 1 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 • „•, 1.. • • . . , . 44.ke[X etoe.4.44.044.44.4.14.144.444 4444- 1;1k- ,* 1S;01'.1"•111-‘-'" • • tr.. .. * 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r y ¢ CITY west yarmouth MA DATE 5/21/2018 PERMIT# P-)T "6 7 JOBSITE ADDRESS 65 beach rd OWNER'S NAME robin tlasek P OWNER ADDRESS 1 TEL 7817526360 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL CI EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES❑ NC FIXTURES 1 FLOOR--• BSM 1 2 3 4 5 6 I} 7 8 9 10 11 12 13 14 BATHTUB It. _IMIII 1 I -r CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 4I DEDICATED GAS/OIL/SAND SYSTEM r- a, �_ -i J DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I----C DISHWASHER E, DRINKING FOUNTAIN alai a mI�'I�_al �II�I�� FOOD DISPOSER ��r 1 f r 1J a FLOOR/AREA DRAIN i INTERCEPTOR(INTERIOR) I{jI KITCHEN SINK - ■■Wr I I I 1 1 LAVATORY SHOWER STALL 111111111rI I f 1 _SERVICE/MOP SINK �_�IIII�� 'I _ -1- T TOILET ins URINAL f f f I WASHING MACHINE CONNECTION f I it WATER HEATER ALL TYPES WATER PIPING Ilia"— 7 OTHER r p � __ � I _ � 1 1 1 � r- [ 1 1- f- f r f ± -1- -1 -f INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El 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 El 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 tru! '/cc • best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in co •%an/I all P-rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / z PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 / SIGNA TIRE MPD JP CORPORATION0# 3698C PARTNERSHIP 0# LLC❑# COMPANY NAME South Shore Heating 8 Cooling,Inc. ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL 2/AgC/E -71-1 ?/ 1 4-1 12