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Home My WebLink AboutP-15-5799 Q t. W1. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r►' _e Vic. �� CITY aric ��l f9 MA DATE 13,11301 I 1 I PERMIT# n/h17P- -06; JOBSITEADDRESS I .I 1'I �] LL- 4 OWNER'SNAMEIhn(110, ) FIIIL.4 i1 I P OWNER ADDRESS TEL Q`'.j Qj• alt IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Er PRINT CLEARLY NEW ❑ RENOVATION:❑ REPLACEMENT:Er PLANS SUBMITTED: YES❑ NOD FIXTURES 1 FLOOR-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 11.110 11I1101.11111. , _h_ I _ _ —ice_ i— _[___ CROSS CONNECTION DEVICE 5 I 51 I r I DEDICATED SPECIAL WASTE SYSTEM ,, , I )L ,I (____IL_ r DEDIC 'L— DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 1 I it 4. I DISHWASHER 1 (j ii C 9 DRINKING FOUNTAIN 1 ( , 11 11F-1 FOOD DISPOSER I II ._— _ Ili FLOOR/AREA DRAIN , i I i I- J - -I-- INTERCEPTOR(INTERIOR) __ - I, )1 _ KITCHEN SINKr 1 -JP_ LAVATORY I- i 1 I t- 11r _ — - ROOF DRAIN _ ) - I 1j SHOWER STALL 1 1 I - I SERVICE/MOP SINK , 1, I G, I ?� •I� _ TOILET I 1 1I Ij 1 URINAL _II I I r � _ d -- t — _I _ I _ -: WASHING MACHINE CONNECTION J. 1 I I _t(� y WATER HEATER ALL TYPESI WATER PIPING , i. If-Ij _ y 1 OTHER t I I ii I _ ;J_ I --- i 11 1 'iII- I F I LaIMi r INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY❑ 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 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 I iia ce inen provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 I SIGNATURE MPO JP EI CORPORATION[j# gfrA/3 G 'PARTNERSHIP❑# LLC❑# I COMPANY NAME South Shore Heating&Cooling,Inc. ADDRESS 57 Whites Path CITY South Yarmouth 1 STATE MA ZIP 02664 I TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL L l tliaL.- 11 80 ' o 41.1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k ff CITY WIT= &urft'AA I MA DATE 1V1 PERMIT# 1 P7,1-0057`i? JOBSITEADDRESSg lireNVAIMMEOWNER'SNAME LUSO 61titkvitt 1 GOWNER ADDRESS ITEL(OI(On'(60511,5 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIALLY PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Er PLANS SUBMITTED: YES NO❑ APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ; _.!i r F F BOOSTER MI I li I i I , COOK STOVE CONVERSION BURNER a an 1 s1 krim one DIRECT VENT HEATER lel DRYER 1111 FIREPLACE FRYOLATOR 11111 ' 1 _ FURNACE r e _GRILLGENEUNfELt'- INFRARED HEATER . LABORATORY COCKS MAKEUP AIR UNIT 1iiIIIiiIIii'j —' UNVENTED ROOM OTHER Rialtilanlininalinalal HEATER l ln I � , , -r— — 1--- , r-- — — 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 ❑+ 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 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 comp lance ith Peytiae[d provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,`�.t/ (//L PLUMBER-GASFITTER NAME Keith J.Famham �I LICENSE# 11601 SIGNATURE MP❑+ MGF❑ JP El JGF 0 LPG!❑ CORPORATION[✓]#�j r ` , M PARTNERSHIP❑# I LLC❑# COMPANY NAME: South Shore Heating&Cooling,Inc I ADDRESS 57 White's Path CITY South Yarmouth STATE MA ZIP 02664 ITEL 508-398-6901 I FAX 508-760-2681 I CELL EMAIL