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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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ib'gl®4 CITY Yarmouth Port MA DATE 06/12/18 PERMIT#Eaft-)r-oevolFG
JOBSITE ADDRESS 34 Minnetuxet Way OWNER'S NAME Anita Desovitch
POWNER ADDRESS SAME TEL 203-323-6304 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL U
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I _ INK MINM MIS MIS 1111.11111111111, Mla,MIN Mt pa
CROSS CONNECTION DEVICE I
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM 11 1 '
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM . Ht j -�
DEDICATED WATER RECYCLE SYSTEM ' OM
DISHWASHER _ EI!ei _ [ 1 11 I 1 1
DRINKING FOUNTAIN I _ j
FOOD DISPOSER I / . I
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't - J
FLOOR/AREA DRAIN —11_ -- Ir _ I- i -_-1.1 Q, J
INTERCEPTOR(INTERIOR) , I __ . ) I
KITCHEN SINK ' .. I . ii �. - I-- ... _ � _ I
LAVATORY , , I.L , 0 I
ROOF DRAIN '1 .- M ... _ I . I
SHOWER STALL 1 t _ J
CONNECTION
HURl
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WATER HEATER ALL TYPES ,�,
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SII111111111,
OTHER :
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WATER PIPING
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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 U NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El 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.
CH,CK ONE NLY: 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 no a act/tie to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in 4, Ha w •- ine provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Keith J.Famham LICENSE# 11601 ' SIGN RE
MPU JP 1:1 CORPORATIONU# 3698C PARTNERSHIP❑# LLC❑#
COMPANY NAME South Shore Heating&Cooling, Inc. 1 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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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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11V—F,, CITY Yarmouth Port MA DATE 06/12/18 PERMIT# 0-g'000
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JOBSITE ADDRESS 34 Minnetuxet Way OWNER'S NAME Anita Desovitch
GOWNER ADDRESS SAME TEL 203-323-6304 IFAX
TYPE OR
PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑' PLANS SUBMITTED: YES❑ NOD
APPLIANCES T FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I 1 I I -_ I . 1) . 1
BOOSTER i tlf _ � i - w i II II- 1
CONVERSION BURNER I I AL- 1 J _IL _
COOK STOVE
DIRECT VENT HEATER I I 1 1
DRYER I �L FIREPLACE
FRYOLATOR
FURNACE I . _ I
GENERATOR i� -
GRILLE
INFRARED HEATER I i
LABORATORY COCKS I _ __I _ I _ _
MAKEUP AIR UNIT 1 II_ _ ; ,.. . . i _ II _I
OVEN .r_ z _ I _ . a
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT 4 ,_ �_ !I, 6 I I d
TEST
UNIT HEATER ., I h I I _ �I_ ___.I
UNVENTED ROOM HEATER _ _ I _ I .- I i I
WATER HEATER 9 _
OTHER rt. I .i I I T7 w4
E N Y
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES D NO ❑
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 information I have submitted or entered regarding this application are true and accura e to th; t of m ••wledge
and that all plumbing work and installations performed under the permit issued for this application will be In compliance wit/ Perti•-n• •r• ion o t'=
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i
PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE# 11601 SIry.MATURE
MP 0 MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION D# 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
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