HomeMy WebLinkAboutBldp-20-001229 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
1'"-- 7.r, CITY Yarmouth MA DATE 8/26/19 PERMIT# / P-It,"'�/ ,
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r<~ JOBSITE ADDRESS 23 Pollock Rip Rd OWNER'S NAME Mike Hatch
POWNER ADDRESS 23 Pollock Rip Rd. TEL 508-364-3364 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL LI RESIDENTIAL Li
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES E] NOLI
FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB p 'i-- ' _ :
CROSS CONNECTION DEVICE
nimannioni
linummon
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM ,,,
DEDICATED WATER RECYCLE SYSTEM ,i 1- ii _ 1 , -
FOOD DISPOSER I
INTERCEPTOR(INTERIOR)
i
KITCHEN SINK 1 II ! f
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
_ I
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1
WATER PIPING
1 _ _ _ _m
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 Ei
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 u AGENT Q
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 curate of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp' e ith ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Keith J.Farnham I LICENSE# 11601 SIGNATURE
MP JPLI CORPORATION 0# 3698C PARTNERSHIP® LLC( #
COMPANY NAME LSouth Shore Heating&Cooling, ADDRESS 57 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901
FAX 508-760-2681 CELL EMAIL info@southshoreheatingcooling.com
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_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
_11= CITY south Yarmouth MA DATE 8/26/19 !PERMIT# 6`a9/SUS
JOBSITE ADDRESS 23 Pollock Rip Rd. !OWNER'S NAME Mike Hatch
GOWNER ADDRESS 23 Pollock Rip Rd. i TEL(508) 364-3364 FAX _ m_ mm
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:Li PLANS SUBMITTED: YES 0 NO71
APPLIANCES Z FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER " IL.
_ .,_ - .,� ._, . �e
BOOSTER l � _ a I
CONVERSION BURNER ' . ._ .a `a j
COOK STOVE I
DIRECT VENT HEATER � II I_ .
. e_ ' I
FIREPLACE 11.111
DRYER
, ' , O.
FURNACE
i
GENERATOR
GRILLE ,
INFRARED HEATER I I. I
3 i
LABORATORY COCKS iQ a„ F _ 1 _ _N m,..� �. . i .__ .. i
MAKEUP AIR UNIT ry
OVEN
POOL HEATER Il i I' l_.... . I !, __.- ._ I ._: _
ROOM/SPACE HEATER
ROOF TOP UNIT
INIT HEATER ,
MI
UNVENTED ROOM HEATER ,_. , _ _ _ _ __In _ _ MI MN _II . 1,,,_
OTHER
I am
1' ' _.. 1 I i im
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LI 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 1-1
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: OWNER1 AGENT l
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 cur he be' f my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp'. e it I Pertinen ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE#' 11601 SIGNATURE
MP ED MGF D JP I_ 1 JGF I__. LPGI 3 CORPORATION # 3698C PARTNERS IP�# LLC[1#
COMPANY NAME: South Shore Heating&Cooling ADDRESS 57 White's Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398 6901
FAX 508-760_-2681 CELL EMAIL info@southshoreheatingcooling.com
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