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Home My WebLink AboutBLDP-19-003076 i gp•Llj . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =we /� v� -1111 CITY south yarmouth I MA DATE 11/2/2018 PERMIT# aM2-5'-'Cvt'76P JOBSITE ADDRESS 35 paine rd OWNER'S NAME ann marie mckenna GOWNER ADDRESS TEL 3947518 , IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONALRESIDENTIALD PRINT ❑ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:E PLANS SUBMITTED: YES]] NOD APPLIANCES1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER h BOOSTER 1 _ 1 I ` 1_ 1 _1 .__ 1 _ U CONVERSIONSTBURNER I + ( 1�f COOK STOVE j\\\- DIRECT VENT HEATER 1i 1II 11 DRYER 1, d . � --- B i 1 tl FIREPLACE FRYOLATOR I' $1 11 FURNACE i-- 1 \ GENERATOR GRILLE INFRARED HEATER imam U LABORATORY COCKS MAKEUP AIR UNIT sans iS 1 OVEN 11 i, ,I ,I I i i' POOL HEATER j ROOM/SPACE HEATER � 1 ROOF TOP UNIT ,I l i _ TEST UNIT HEATER _ i; r� W�IWf - 7 UNVENTED ROOM HEATER �`� iii 1 I WATER HEATER OTHER [ 1 1 1 1 I i � I 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 a 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 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. PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 1 SIGNATURE MPD MGF❑ JP DI JGF❑ LPGI❑ CORPORATIOND# 3698C PARTNERSHIP CR LLC D# COMPANY NAME: South Shore Heating&Cooling, I ADDRESS 57 White's Path • CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL } f. • ar .i: S . • qp / ii ._. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -s�i= z_ CITY south yarmouth MA DATE 11/2/2018 PERMIT# Fj i219- 01070 JOBSITE ADDRESS 35 paine rd OWNER'S NAME ann marie mckenna POWNER ADDRESS TEL 3947518 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB h II _ . _— ' CROSS CONNECTION DEVICE i1 IW , DEDICATED SPECIAL WASTE SYSTEM 1 1 I I i 1 II I DEDICATED GRESDSYSTEM I 1 I i il�;, II DEDICATED GREASEASESYSTEM DEDICATED GRAY WATER SYSTEM I DEDICATED WATER RECYCLE SYSTEM „ l DISHWASHER I a DRINKING FOUNTAIN ' 1 Ii. h I, a a ii If I..FOOD DISPOSERoII I ,� li I� l 1.FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1. II�i II KITCHEN SINK ' I � I LAVATORY I- �i ROOF DRAIN -1I— I SHOWER STALL I SERVICE/MOP SINK 1 TOILET ' URINAL WASHING MACHINE CONNECTION : h p I I WATER HEATER ALL TYPES WATER PIPING OTHER r Ir i n 1. 7, a1 , II r 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 Q OTHER TYPE OF 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 ❑ 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. PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SIGNATURE MP JP CORPORATION El# 3698C PARTNERSHIP❑# LLC Di COMPANY NAME South Shore Heating&Cooling, ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL r_c/ipja waY-7 bv32 //o- fv)