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Home My WebLink AboutBLDP-19-001797 ric ' I 4 ,l� m /Vf�VVi MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,s r i'' �j�Q MA DATE O/zvi (PERMIT#,WP/?'0d r tan_ ii CITY 1 JOBSITE ADDRESS L31Se a,i 1k d— ( OWNER'S NAMEraalli A nth f(n 1 P OWNER ADDRESS TEL 1 $TJ L. FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Y ( PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: " PLANS SUBMITTED: YES❑ NOD FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUBr_ 1 - _I__ I� — r. 1 _ __ 4 — CROSS CONNECTION DEVICE i �..1 I— I H- T f- 1 1 I DEDICATED SPECIAL WASTE SYSTEM _, I 7 `i !- 7-1 -meq DEDICATED GAS/OIUSAND SYSTEM 1,_,.., l---11 1 {' (J-tl-1 1--'-'.i— li 1. DEDICATED GREASE SYSTEM I,I 1 i I DEDICATED GRAY WATER SYSTEM 1_,.._ 1----1 , ,.r .1—'1 .1- i ,Cil `, DEDICATED WATER RECYCLE SYSTEM ;x.,•_11— I 'I- '; ..E-- , DISHWASHER r. , t I— I I I ',I DRINKING FOUNTAIN _ 1 I ii -AI j 1—" FOOD DISPOSER s_ . Ii - r Fr 1 F F. .i----.1 ' FLOOR/AREA DRAINI I J i t INTERCEPTOR(INTERIOR) j _�� 1 _ !I - 1- 1 H! j KITCHEN SINK 1 1 'I 11 r _i._. LAVATORY I h�I 1 t ROOF DRAIN - _ SHOWER STALL 1 I I I - SERVICE/MOP SINK ...;1_, '_ , .:I 'i 1 ,1 'Ir`rp - t -,1 TOILET 'i 1` — L I URINAL I — RTrn.. WASHING MACHINE CONNECTION 7 �I (1" WATER HEATER ALL TYPES I 1 11 i .I WATER PIPING - 1.7 7 1 l 1 - OTHER - . 111111, - I in, , _,, , r, rui, .1 ri milmiliniiiiiiiiiiimatr- -Twor . sus= on 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 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 Inc ce 'h al inen provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Farnham 1LICENSE# 11601 SIGNATURE MPD JP❑ CORPORATION #qq/ C. PARTNERSHIP❑# LLC 0# COMPANY NAME South Shore Heating&Cooling,Inc. J ADDRESS 57 Whites Path CITY South Yarmouth 1 STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL . I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# kpi r/L`'/ PLAN REVIEW NOTES j I __ 1�- ► wry So- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK iF 7r u ail CITY k • sI sita MA DATE[ PERMIT# 401?-00 /77 JOBSITEADDRESS[7.55fl0-v...— 'c ti IOWNER'SNAMEDuS&yg4nLrivo G OWNER ADDRESS TELrcj)�rpi'J FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW;❑ RENOVATION:[i REPLACEMENT:Oe PLANS SUBMITTED: YES NOD APPLIANCES 1 FLOORS-r BSM 1 2 3 4 5 6 7 8 9 10 la 12 13 14 BOILER 11111a11101111111XISS _ BOOSTER SM'ISISS '' S SWIIIISI CONVERSION BURNER IMINININErSiISISLIIIIIMINS COOK STOVE • 111SW1101111111111SMISSONSOMMIltalla DIRECT VENT HEATER ISSIIIIIIIMINIESIIIIIIIMEWIESIMUINSIMMII DRYER ilitaliallair ISIMUINIIIIINEN_ �� FIREPLACE 'SE !_• •__ • tJ FRYOLATOR II MIf_ISMEN Ia ■� 11MO FURNACE MileallMilatillitSalliellitailliiiiitilli GENERATOR alMillitilialiallialitlaillitill1011011111MIS GRILLE SMIIIIIIIMMISMIUNIIIMMINSIMMISI INFRARED HEATER 5 SlintliNOMMINIMINSIMIMINataitaitelS LABORATORY COCKS � _ _IMAKEUP AIR UNIT ' � i _ __ OVEN IIIIIMISSOISISSIIIIIIIMIONU 1'awiet_ i■ b POOL HEATERlii IIINI I _wirr11F11�1_�_ 1 ROOM I SPACE HEATER IIIIIIMMISSIMUNISI INESIONINUENME SIM ROOF TOP UNIT (S ` 011111**IZMINIUSS TEST Sr��I�_�7_��r— r��rry��—�s ___ MSS UNIT HEATER II_r_ Ill IIII �MI wA____ DE"ART StMKS UNVENTED ROOM HEATER r I IIIMISIMINEM_ MIS WATER HEATER OMMOIiININaSSI—ISIME_ OTHER 5SINIEM j r .£-. IM, INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY Q 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 infomiation I have submitted or entered regarding this application are true and yanccurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in comp lance epiu Peciprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -Y{ (Jy PLUMBER-GASFITTER NAME Keith J.Famham LICENSE#F6-01-1 SIGNATURE MP Q MGF El JP❑ JGF❑ LPGI❑ CORPORATION d# Noq 6. 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 1 CELL EMAIL • I o