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Home My WebLink AboutBLDP-15-000029 1 f r0–' t ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK --r= 1_=�t CITY yarmouthport l q I MA DATE 7/11/14 1 PERMIT# P✓ 9 JOBSITE ADDRESS 4thacher shore rd I OWNER'S NAME Randall,John P OWNER ADDRESS I TEL 508-362-9064 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ID PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES 0 NO❑ FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB SIMMOSSEISIMISSISINISliitint CROSS CONNECTION DEVICE fl5SSS' 'S_SS,WSSS DEDICATED SPECIAL WASTE SYSTEM � jannallallailiallkilla DEDICATED GAS/OIUSAND SYSTEM gisimommes____ns , am DEDICATED GREASE SYSTEM NEMINNIMMENalalalaliSIMINNIIMINit DEDICATED GRAY WATER SYSTEM AnosimssaaS aS''Smos DEDICATED WATER RECYCLE SYSTEMSMASSIMIn 'na55_- DISHWASHER ImmENNINKSIMINSMINENExamitimulinalialitiiiMimilent DRINKING FOUNTAIN IS151.1.111SEISIIIIMISINeisTSOMMISmOnit FOOD DISPOSER �ISIMM �IM �� liallia FLOOR/AREA DRAIN Illitilit �� INTERCEPTOR INTERIOR SOu� �� KITCHEN SINK0111/4 LAVATORY S_�SI� ROOFDRAIN ��SillaNNIIIIIIS� SHHOWEEST R STALL ��allellS SERVICE/MOP SINK imiliallisiMilintilliannailialatimiltilltnimea TOILET fli565_sa��a� q�na asa URINAL WASHING MACHINE CONNECTION aS ,SsiSa% i■ WATER HEATER ALL TYPES 11101111111111011111110111101.0111111.110.11111.111011101111110111111111119110 WATER PIPING _� 1Mn� MS � OTHER l�� 555555'ISS. elS__s illitafallielliiMMIS_ aliernialealmitimillinalumtimealintialsigiatst INSURANCE COVERAGE: I have a current Liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE OF INDEMNITY 0 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 El 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 the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. re/pt W-cl .,i PLUMBER'S NAME Edward Caswell I LICENSE# 9119 SIGNATURE MPD JP EI CORPORATIOND# 3655 PARTNERSHIP❑# LLC 0# COMPANY NAME) Cape Cod Gas Heat and Ac inc I ADDRESS 15 Jan Sebastian Dr#d4 CITY)Sandwich (TATE MA ZIP 02563 1508- 39-9303 `' :'� FAX CELL (EMAIL info•ca.ecod.as.com e111111111111111011111111— nom L , I I %/ripj-ilttar ptt'nl<Ti.�.�0•.l L/ :at MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _m-c IT':'_'±liL 7� CITY YARMOUTHPORT MA DATE 7112/14 PERMIT# bis— 029 JOBSITE ADDRESS 39 THACHER SHORE RD OWNERS NAME FLORENCE GALASKA GOWNER ADDRESS TEL 916-599-6658 FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONALRESIDENTIALEl PRINT ❑ CLEARLY NEW:❑ RENOVATION:E] REPLACEMENT:Ld PLANS SUBMITTED: YES NOD APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER nasa _ a Vil 3 CONVERSION BURNER 1 COOK STOVE I DIRECT VENT HEATER 01 0 i DRYER FIREPLACE j- --5 FRYOLATOR 111011111110.0111110111011111011100000110111111111101001101111011111011111101111 ____ • EL : . Y t W OVEN smiustamassimustisaminsuratosow POOL HEATER sammtsmoisemaissonammisuaniona TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I , '11111101.11111010101MMININNIONINCOMIEMOSIMPOWIMMOINIIIMME of pr , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 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:l 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. /'t I 6-4-4A4 ' �� 11f1 PLUMBER-GASFITTER NAME EDWARD CASWELL LICENSE#1-6T11-1 SIGNATURE MP El MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION # 3655 PARTNERSHIP 0# ILLC❑# COMPANY NAME: CAPE COD GAS HEAT AND AC INC ADDRESS 15 JAN SEBASTIAN DR#D4 1 CITY SANDWICH STATE MA ZIP 02563 TEL _ ____- FAX f CELL EMAILIINFOaICAPECODGAS.COM ` ` L. �� L- ' f t= Li I J/UL 14 2011, I all ii_uING Eii,i�l"nl_`:i By obi (wig 74/r(