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Home My WebLink AboutBldp-19-006742 r°r4/11.Y/W2 / 1 , ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ~I i CITY rAt inc" V t _ MA DATE SZI0' ur ! ,PERMIT#6A0P d77j'C JOBSITE ADDRESS 9 ITV N ur rt A ` ' OWNER'S NAME P i k r r 4:9 a"iv i e r P OWNER ADDRESS ,r`rif T riFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Lj EDUCATIONAL Ej RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:Li REPLACEMENT: PLANS SUBMITTED: YES 0 No 004 FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Sj CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _.® 1 DEDICATED GAS/OIL/SAND SYSTEM _ _y _ ___ t , DEDICATED GREASE SYSTEM 1_ _ ._,J( DEDICATED GRAY WATER SYSTEM I ., .. . .. _ Iv...._ ,_ I. g,.. DEDICATED WATER RECYCLE SYSTEM DISHWASHER inurn - Rouninno DRINKING FOUNTAIN 1 FOOD DISPOSER iiimmormitunt minowilitimmumormaliontuntime FLOOR/AREA DRAIN milimmummeini _ , moan KITCHEN SINK LAVATORY IIIIIIIIIIMIIFIIIIIIIIIIIIIIIIIIUIIIISIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIOIIFW ROOF DRAIN IIIIIIIMIINIIIIIIFIMIIIIIIIIFIIIIFIIIIIBIIIIIIIIIIIIIFIIIIIIIIMIIIIIVIINIIIIIIIIIIII SHOWER STALL 11111111111111111111111111111Willinill.111111111111111•11WilliWINII SERVICE/MOP SINK I IBA TOILET 1111111EVRIBIll I NM '0 WATER HEATER TYPES L _..... iii• WATER PIPING 1 MI 1 u,______ . _ , _ . .. ___ _ _.._ I _ ...___ _. _ ._ . ... _ _ __....._____ _ _ .. ...' i__ i .._.__. __ RRiU . ..... 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 0 OTHER TYPE OF INDEMNITY D BOND I_.._I 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 ONL : 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 u and cc o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c ianc wit II Pe in t ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Farnham _M.. M y LICENSE# 11601 SIGNATURE MPL JP CORPORATION# 3698C PARTNERSHIPL._I# Lc Lk COMPANY NAME South Shore Heatin. &Cooling_, Inc. ADDRESS 57 Whites Path CITY South Yarmouth �-i STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL ly-) 6 e ,S 0L i I1n�C06'1±(Y3 .CCJc)-)„ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El ❑ FEE: $ PERMIT# P2- PLAN REVIEW NOTES !�//� ✓ V/fr? --.• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK c-=`;lifer; CITY -me V j, —1 �,MA�/}}DATE .SAd/l , PERMIT# 'R— (ill l JOBSITE/ADDRESS 9 �/V A) L it' fa• IOWNER'S NAME t I f 17 —ap t C°r` GOWNER ADDRESS y4l141.0 vOlt p O r1- I TOO-ZIAS' 96r I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL D RESIDENTIAL 0 PRINT �,�r� CLEARLY NEW:Li RENOVATION:D r REPLACEMENT:(� PLANS SUBMITTED: YES El NO[e"". APPLIANCES 1 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 5D BOILER ...e ,. .. .. If _ I_ 1_ _ u _ : . _ BOOSTER CONVERSION BURNER 1 II I COOK STOVE ' I ' DIRECT VENT HEATER 1 . ' I . i DRYER FIREPLACE - .'_. e., . . . _ i _.,_ 'u_ .a' ._ L _d , _. FRYOLATOR J 1 ,1 FURNACE GENERATOR GRILLE I I INFRARED HEATER LABORATORY COCKS I II��I� �� MAKEUP AIR UNIT OVEN -•• - UNIT HEATER , , WATER HEATER o-rH ER IIMININI.11111111 MI 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 j NO Lj I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY Li BOND L 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: • NER Ej AGENT Ej 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'. :CCU':te t est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl..j e wit;/all nen r won of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 I y SIGNATURE MP LI MGF® JP® JGF D LPGI LD CORPORATION j# 3698C PARTNERSHIP LI# LLC®# COMPANY NAME: South Shore Heating&Cooling, Inc I ADDRESS 57 White's Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# T / 0 C�`Z PLAN REVIEW NOTES g y ✓//9