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Home My WebLink AboutBLDP-18-006873 rZsQ, .� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK; , _ rn CITY y, ovtrt I MA DATE I5/2///81 PERMIT# P',P'0C/�/.7yg JOBSITEADDRESS '9 C A.n rte✓G4.7lel I OWNER'S NAME n ffit,/fSa/7Cran r P OWNER ADDRESS ._Cc V, 014,1 I TELV7fl&33-I%i IFAX I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL a PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOP"- FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB [ P_ I r it r r 11 I- r I CROSS CONNECTION DEVICE [ I i i i 1 I DEDICATED SPECIAL WASTE SYSTEM 1 .. _I _ DEDICATED GAS/OIUSAND SYSTEM ,Mr r r r DEDICATED GREASE SYSTEM .i DEDICATED GRAY WATER SYSTEM $ DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 1 INTERCEPTOR(INTERIOR) KITCHEN SINK r LAVATORY II 1 ROOF DRAIN i i SHOWER STALL ; SERVICE/MOPSINK I i it if TOILET it a ,� URINAL O WASHING MACHINE CONNECTION I - WATER HEATER ALL TYPES -Ii WATER PIPING p OTHER , F r7 r r IT 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 ❑ 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 Q 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 nd:cc - - .the .est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn nc-� all Pertin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER'S NAME Keith J. Famham LICENSE# 11601 7 ' SIGNATUR MPD JP❑ CORPORATIOND# 3698C 'PARTNERSHIP❑# ILLC❑# COMPANY NAME South Shore Heating&Cooling,Inc. ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 1 FAX 508-760-2681 CELL EMAIL G24 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES • Yes No THISAPPLICATIONSERVESASTHEPERMIT 0 0 1 / ,/lam FEE: $ PERMIT# PLAN REVIEW NOTES I/6 • t '+-1 MASSACHUSETTS�U�NIF�ORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` _t CITY fir-in (/✓IF/ - 1 MA DATE pE,7®t& PERMIT#,t� 1' (P —/I^CV % 23 JOBSITEADDRESS�P G i*ttid/OAl64r y sect ll wino? e IOWNER'S NAME e,yJ' not GOWNER ADDRESS S.7 4-rm o-agit ITE77F-?Ge'/ILS FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIALQ PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:EJ PLANS SUBMITTED: YES NOOr- APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I.. , , i i BOOSTER CONVERSION BURNER t �,I �� t �� II f r COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE r P 1 a ii i , i FRYOLATOR1I FURNACE _ i GENERATOR I r GRILLE INFRARED HEATERi LABORATORY COCKS t r i MAKEUP AIR UNIT 111 OVEN Il POOL HEATER ll i 1-_, i ROOM/SPACE HEATER I ROOF TOP UNITI TEST - r—, - - r UNIT HEATER UNVENTED ROOM HEATERi i WATER HEATER r r r r � OTHER F H O 11 1I INSURANCE COVERAGE I have a currentJiability 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 a 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 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true an. .,. urate • best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli-••- kithajI' Pertine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I i PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 / SIGNATOR MP Q MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 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 // tp/7' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 r2/al/ k. / FEE: $ PERMIT# PLAN REVIEW NOTES \ o