HomeMy WebLinkAboutBldp-19-006550 M 1
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Gf - CITY Yarmouth Port MA DATE 5/9/19 PERMIT j —Gt? .
JOBSITE ADDRESS 106 Pompano Rd. OWNER'S NAME Krista Sabbatino
POWNER ADDRESS 106 Pompano Rd.Yarmouth Port 1 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL ® RESIDENTIAL El
PRINT
CLEARLY NEW: [ RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES® NO®
FIXTURES 1 FLOOR—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB �_- 1I. , _ U (I . it ,
CROSS CONNECTION DEVICE ) 4 - — . - ,, _... ,___
DEDICATED SPECIAL WASTE SYSTEM 4 I ii U
DEDICATED GAS/OIUSANDSYSTEM _ v _IL �{_ �( t
DEDICATED GREASE SYSTEM I___ ! _
_ _ 1 _. 1
DEDICATED GRAY WATER SYSTEM 1 r 4 1.1 i IL._ _
DEDICATED WATER RECYCLE SYSTEM 11
DISHWASHER
DRINKING FOUNTAIN ,' '
FOOD DISPOSER _ _
FLOOR/AREADRAIN i ����. I
1 , ')
INTERCEPTOR(INTERIOR) J. �._- � a_ ' l_.-. u
KITCHEN SINK J ; w
LAVATORYIMIr
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK 1 _ �'
TOILET � �
URINAL 1
I NM
WASHING MACHINE
TCONNECTION _1 { �
WATER HEATER
WATER PIPING = lintrauanwairmuwwwwwwww
OTHER _ _ _ I
, 1 _ _____ .._, __ _ n
_________ __
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Li 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 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 tru nd a cur to th my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co lance 'th Pe en provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Keith J.Farnham__ LICENSE# �11601 SIGNATURE .
MPU JP® CORPORATION Q# 3698C PARTNERSHIPED# LLC0#
COMPANY NAME South 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
". MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
S'.2 CITY !Yarmouth MA DATE 5/9/19 PERMIT# 1 �/h-0O 6-, •
JOBSITE ADDRESS 106 Pompano Rd.Yarmouth Port OWNER'S NAME Krista Sabbatino
GOWNER ADDRESS 106 Pompano Rd.Yarmouth Port TEL FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL J RESIDENTIAL LI
PRINT
CLEARLY NEW: RENOVATION:® REPLACEMENT:Ld PLANS SUBMITTED: YES® NO
APPLIANCES-1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER i , I `.
BOOSTER ;; ... �...� i . ., ..._ . -:_..m . ....._- �.
CONVERSION BURNER '
COOK STOVE
DIRECT VENT HEATER
j
DRYER _ I___. _�
FIREPLACE _. `� .� _ li__�r _ I m�_ _ Lm i... ..
FRYOLATOR - b °!I m..��� L ';
.1 _ ,I . _I
FURNACE i . �INN� ',�.. �...al ..._..
GENERATOR i! —ri — , 1 _, ,.GRILLE
INFRARED HEATER
LABORATORY COCKS 1 mi
MAKEUP AIR UNIT ' '
OVENli
POOL HEATER RRRWRRRRRRRRRIR
ROOM/SPACE HEATER
ROOF TOP UNITa
TEST . R._r i,_ a._l I_.., 1 _.
UNIT HEATER I,-- 1 ._` .,' I
UNVENTED ROOM HEATER 1 ,.. .__ .
WATER HEATER !___I._ _I_ _ f�_ ___.. 1
OTHER
f I ,i I
.f
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 D BOND Li
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 1_, I AGENT ni
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 d urate 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 c wi e 'nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Keith J.Farnham - _- LICENSE# 11601 S URE
MP,._i_I MGF I J JP.J JGF _mm" LPGI I --.I CORPORATION LI# 3698C _ PARTNER ER HIPI_,J# _ LLC�__# _ M_,
COMPANY NAME: South Shore Heating&Coolies ADDRESS 57 White's Path
CITY South Yarmouthr ..� STATE MA IZIP 02664 TEL 508-398-6901
FAX 508-760-2681 CELL EMAIL infoa@southshoreheatingcooling.com
L/P/1
"
R
l
N