HomeMy WebLinkAboutBLDP-18-006090 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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DATE( i-pP' iPERMIT# , t-'t6�dr°
JOBSITE ADDRESS £(O (2.,E-"Sd1- woo OWNER'S NAME 36-41 42041 ,9fr fraNttY9•— I
P OWNER ADDRESS z(17 d74-- ' TEL 3..74.---- 00LtJFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑' PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 8 ' 9 10 11 12 13 14
BATHTUBI 11111 r r
CROSS CONNECTION DEVICEI
DEDICATED SPECIAL WASTE SYSTEM lr d i Ir
DEDICATED!!&LM
M !!!!!!!!!'!!!ICATEDICATED ICATED TEM r.
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
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INTERCEPTOR INTERIOR
KITCHEN SINK i I
LAVATORYI
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ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK i
TOILEURINAL 1 i i d
WASHING MACHINE CONNECTION I ir I :-
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WATER HEATER ALL TYPES
WATER PIPING , I
OTHER r „ i i I
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES O NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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 0 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 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 in compliance with6 all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. kscm,
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PLUMBER'S NAME Keith J.Famham LICENSE# 11601 STATURE --,„....,
MPO JPD CORPORATION O# 3698C PARTNERSHIP❑# 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
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES%"
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT# P�-J�W1' C /k& 0)-(
PLAN REVIEW NOTES
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TOB PERFORM GAS FITTING WORK
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JOBSITE ADDRESS Ail' GJirS � &O A' 'OWNER'S NAME e / LzL
GOWNER ADDRESS /}/Y72fr""v,,nt/pn0r ITEL W7 oot, AX
TYPE OR Y
PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El
CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NOP
APPLIANCES 1 FLOORS-, 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER f r jr i [ I- [ I
BOOSTER I 1 1 i
CONVERSION BURNER ql I _ I ,,„.1, I _ _ ,Li
COOK STOVE .`1 I 1 1 ',),
DIRECT VENT HEATER 1
DRYER J. I 1 1 I ll
FIREPLACE h I I _ 'I SII- I
FRYOLATOR I J..-. .�
FURNACE �� I 1 11 s, moi] aw, �IJ I.. _
GENERATOR I II _ 11 ., I 1 _ I,. 1., ._ I' _
GRILLE _ ,I 'I '
INFRARED HEATER - V r
LABORATORY COCKS _ =I L .' __ F , I_ I _ J '
MAKEUP AIR UNIT
OVEN L .I 1
POOL HEATER -_ 'I _ L. 'I J 11 I
ROOMISPACEHEATER
ROOF TOP UNIT _____ ___--iJ - -., , . _ I _ I_ . I_ .m- ___ I. , wu L 1 I
TEST I _q_ V1 _ I � !1
UNIT HEATER _ I I i I IL r
UNVENTED ROOM HEATER ; If I l l 11. ,
WATER HEATER 4, _.'J .__ _ '1 1 'I 1I
OTHER .'L 'I 1 j 1 I
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IIl LI q 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 ❑ 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 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 In compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
_ ' - %t.
PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 !.I' AT 'E
MPD 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
LRA -
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ / ,E
FEE: $ PERMIT# t/67-- `` ��✓
PLAN REVIEW NOTES J/J K r_/ i!G
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