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Home My WebLink AboutP-19-000288 9 • IP., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK mnom. n 'sUl= CITY yarmouthport MA DATE 6/18/2018 PERMIT# /"19"-"GaW JOBSITE ADDRESS['• hl l C$on 061 OWNER'S NAME yvette robida GOWNER ADDRESS TEL 3629035 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL0 PRINT CLEARLY NEW:❑ RENOVATION:CI REPLACEMENT: '❑ PLANS SUBMITTED: YES NOD APPLIANCES 2 FLOORS—. BSM1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERni_ �r BOOSTER IL „ CONVERSION BURNER COOK STOVE DIRECT VENT HEATERI i I ) ,, DRYER II I i FIREPLACE � r 1 ____F IMM, r J FRYOLATOR I FURNACE GENERATOR 'r -I-1�, l GRILLE o INFRARED HEATER I 1 LABORATORY COCKS 1 MAKEUP AIR UNIT I OVEN I6 6 d POOL HEATER i 1 ROOM/SPACE HEATER ROOF TOP UNIT ,, TEST i UNIT HEATER , UNVENTED ROOM HEATER WATER HEATER x I OTHER d ,i ,Iii u I I I I 1 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 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true a • acc ate o th- •- my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in co?. e wit, all; I ent prov'pion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i . PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 / SIGNATUR MP a MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C 1 PARTNERSHIP Q# LLC Q# 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 2 • _t /r-Er/441-c /zc Q/_ //r f 4 A. r'-14 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ';esc4 CITY yarmouthport MA DATE 6/18/2018 1 PERMIT# /1--DPITLICniftir JOBSITE ADDRESS L7- Ki+& on Vim OWNERS NAME yvette robida P OWNER ADDRESS TEL[3629035 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1r 1r 1 1i - Iit -11 I I ir e l CROSS CONNECTION DEVICE - ' - - - -- DEDICATED SPECIAL WASTE SYSTEM I DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM I i i I _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER ,i 1 1i DRINKING FOUNTAIN 8 , I i FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) i. 1 KITCHEN SINK i LAVATORY I ROOF DRAIN i 1 SHOWER STALL I SERVICE/MOP SINK TOILET URINAL �� __ WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES x WATER PIPING ,I OTHER f _ l � ',la Ir 1 I �f ii II i T v II_ 1 �r if - lr �� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a 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 ❑ 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 nd a 'urat: o t - •- . . nowledge and that all plumbing work and installations performed under the permit issued for this application will be in co ante , th ay'e��III►►{ nt provis of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,. PLUMBER'S NAME Keith J.Famham LICENSE# 11601 / SI NATURE - MPQ JPO CORPORATION Q# 3698C PARTNERSHIP❑# LLC 0# 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 &R H- PPI/VO-C a Lie //02