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Home My WebLink AboutP-15-5829 ^tea MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ratite yf ITV West Yarmouth I MA DATE 2/13/2015 PERMIT# ftni,er—001 9 JOBSITE ADDRESS 20 Payson Path OWNER'S NAME Clare Coughlin OWNER ADDRESS I TEL 508-932-8545 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL U PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑� PLANS SUBMITTED: YES❑ NOQ 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 I DEDICATED GAS/OIL/SAND SYSTEM I I I 1111111 DEDICATED GREASE SYSTEM NS MR 5S MI MI WMjS'S Ma 11111101111EIS DEDICATED GRAY WATER SYSTEM S Sigisalisiariglinnalifla DEDICATED WATER RECYCLE SYSTEM nn 11111111111111111111 S S ma MI Ma MN MINS a ma pa S DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER NM NSa Ia K Mt M M_Mt Ma FLOOR I AREA DRAIN / INTERCEPTOR(INTERIOR) KITCHEN SINK n r Imo_MIma iiniF LAVTORY INE NC MIS MIN 1.111a MIN a OOAFDRAIN I IMSISMI ME MNM11111C-11111111 MI SHOWER STALL Min MNMIMN55,55NMI S_�s SERVICE I MOP SINK JeR MEL MIN Ma I NMMI TOILET URINAL 1 1 WASHING MACHINE CONNECTION , ,_ WATER HEATER ALL TYPES est n WATER PIPING OTHER _MU _ MIR MMt M �S MI i 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 ElOTHER 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 tru and ccur to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co rice- ith II entp ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f PLUMBER'S NAME Keith J.Famham LICENSE# 11601 SIGNATURE MPU JPD CORPORATION # 3698C PARTNERSHIP 0# LLC❑# 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 fcPfl#C "z_c, a/to z4eg-- 1?/7 .. , ---- <E5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFO GA• FITTING i ORK Pr. ilea' i 'AWLS,` - West Yarmouth MA DATE 2/13/2015 PER # /'iiPP e-OrdOa? JOBSITE ADDRESS 20 Payson Path OWNER'S NAME Clare Coughlin I , GOWNER ADDRESS TEL 508-932-8545 I- TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIAL DI PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:ID PLANS SUBMITTED: YES NOQ APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER L_ _ r._ __it — 1 Il.___ ill l - r I _._,_ [ I BOOSTER CONVERSION BURNER — COOK STOVE I __ U DIRECT VENT HEATER DRYER L . . ,t... 1 , s _ .I FIREPLACE _ ,. - a • iii , FRYOLATOR II , FURNACE �, ,f _ GENERATOR GRILLE _ U _ INFRARED HEATER __,ll ._ It — I LABORATORY COCKS L._._ Ima 1_ MAKEUP AIR UNIT __ _.I -_—_il _..__ _ OVEN , ,a , ' ...,.1 I �, POOL HEATER L.- u. ROOM I SPACE HEATER ' _ 1 _ ROOF TOP UNIT t L TEST t UNIT HEATER I) I UNVENTED ROOM HEATER IS 1 WATER is OTHER HEATER 1_, I t _,. r . Ir i II 1 i I . r ' I I - 1 I - I q 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 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 D 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 tts State work andininstallations performedpten1 under thetGe permit Issued for this application will be in com t/6 wit all/9Aineat-prov of the Massachusetts State Plumbing Code and Chapter 142 of General Laws. ' / -arµ{/ Z PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 I , SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION Q# 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 ( kid1 L. Pif 216// -->c7 F7119 72-eHtS