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Home My WebLink AboutBLDP-19-003376 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ 7:71 GIS CITY YARMOUTH , MA. DATE 11/30/18 PERMIT#se2PHist12 93X JOBSITE ADDRESS)102 FREEBOARD LANE OWNER'S NAME 1 SHERPA POWNER ADDRESS:1 YARMOUTHPORT TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO D FIXUTRES 1 FLOORS tit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER • DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES t WATER PIPING INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ID NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ 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 0 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 in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Diasi PLUMBER NAME:)LEON E CLARK,JR. I LICENSE# 11734-M S GNATURE 191— COMPANY NAME: I TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY:)SOUTH DENNIS )STATE: MA ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL 508-367-1452 EMAIL:)karen@tcplumbing.net MASTER CI JOURNEYMAN 0 CORPORATION # PARTNERSHIP 0# LLC 0# , n /Lc afko L/Pr/02//fr MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =tjc CITY YARMOUTH MA. DATE 11/30118 PERMIT#6/S2/79099-4149 JOBSITE ADDRESS 102 FREEBOARD LANE OWNER'S NAME SHERPA GOWNER ADDRESS: YARMOUTHPORT TEL• FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 _ EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:I PLANS SUBMITTED: YES❑ NO t FIXUTRES 7 FLOOR-. Bsmt 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 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ❑D NO D If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are We 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. PLUMBERIGASFITTER NAME: LEON E CLARK,JR. LICENSE# 11734-M SIG TURE COMPANY NAME: TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY: SOUTH DENNIS STATE: m ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1452 EMAIL: karen@tcplumbing.net MASTER 0 JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# y7 • Dia -11/111'J