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BLDP-19-002719 _y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Mc It_ CITY West Yarmouth MA- PATE 1115JI018 PERMIT# /Z oC' 7H . JOBSITE ADDRESS 121 Camp St. Unit#105 OWNER'S NAME Mark and Mary Petruzzi n OWNERADDRESS SAME TEL 508-8274778 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 16 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:Igt PLANS SUBMITTED: YES 0 NO V FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/01L/SAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SERVICE SHOWER STAU_MOP SINK RECFIVFF fl TOILET URINAL NU\ 05 2016 WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES i Al ILDIN3DEFARTNENT WATER PIPING er ------- OTHER • INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES p NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUiYINSURANCE POLICY © OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANC WAVER:I am . • the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts, r l La ,•., I1 t my sir .lure on this • n. .,p'cation waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF • • •' ENT I hereby certify that all of the details a • atlon I have submitted or entered regarding this application are true and accurate to the best of my koxiedge and that all plumbing work and installations performed under the permit Issued for this application will be In comp. a with all Acne vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //� PWMBER'S NAME Scott Reid LICENSE ti PL16354-M SIGNATURE MP 0 JP❑ CORPORATION❑# PARTNERSHIP❑# LLC(]# 82-2993476 COMPANY NAME SR Plumbing ADDRESS PO Box 222 CITY Harwich Port STATE- MA ZIP 02646 TEL 508-241-3773 FAX CELL Same EMAIL SRPLUMBINGLLC@GMAILCOM C �� X40 ` lfi .4 i . ,,g///, '� 1 , '> MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R/ CITY Uer K .iI% / MA DATE Il/Ma// PERMIT i /.i-i.•i' /9"tt1 V/? JOBSITE ADDRESS /2-/ aryl/ oh #?1x0r OWNER'S NAME/f/litI /-Very /"G/N2tj OWNER ADDRESS � TEL SDY4 747?7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL[•— PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES 0 NO 15-- APPLIANCES 1 FLOORS-, SEM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS . MAKEUP AIR UNIT OVEN POOL HEATER RECEIVED ROOM I SPACE HEATER ROOF TOP UNIT NU o. 2O TEST ...._ ..... UNIT HEATER UNVENTED ROOM HEATER a}FEEING DCry�ry WATER HEATER OTHER INSURANCE COVERAGE ,.,�,� I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES E NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY OTHER TYPE INDEMNITY 0 • BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the lice :- does not have the insurance coverage required by Chapter 142 of the Massachus- Gener. •. • • -t my sir • • on this permit application waives this requirement. • CHECK ONE ONLY: OWNERAGENT ❑ 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 ' all Pertinent provision of th Massachusetts State Plumbing Code and/IChh/aptter--11,42 the General Laws. PLUMBER- ASFITTERNAME 55p'IT I`'A/a UCENSE#fi/1Jjy.4/1 SIGNATURE MP MGF❑ J`Pn❑ QJGF 0 LPGI 0 CORPORATION❑41 PARTNERSHIP❑1I LLC # COMPANY I4AME ./ a. f iU1'u RQ fax 22f� ??-' ' "y7{' y/ L A,� ADDRESS 'f �/ CITY A,�/G1 /LY7 STATE/vrt ZIP 6 ?67dA' /T'EL,e - T-2@ ,777y FAX CELL EMAI LS RU LUM81) ! LLl964,91 OA/ • G,-tJ-lnt/ tie it LIQ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ -9 • • FEE: $ PERMIT# Air !�� C/' PLAN REVIEW NOTES I f • • J � ,