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HomeMy WebLinkAboutBLDP-20-001569 3LO 1,„... ....,,,-) •„ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK irw=cY s=Fi=y& CITY Yarmouth Port MA DATE 9/12/19 PERMIT#(LLD(' "0 0's !G JOBSITE ADDRESS 120 Wianno Rd. OWNER'S NAME Amy Naas POWNER ADDRESS 120 Wianno Rd. TEL 508-362-4424 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL 13 RESIDENTIAL J PRINT CLEARLY NEW:El RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES .. NO FIXTURES Z FLOOR—* BSM 1 2 3 4 5 6 7 8 9 -10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 11 NI j DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I DEDICATED WATER RECYCLE SYSTEM 1 ___r H . A 1 DISHWASHER .. 1. DRINKING FOUNTAIN 1 I _. I 11 11 I FOOD DISPOSER r� FLOOR/AREA DRAIN Ii 1 INTERCEPTOR(INTERIOR) KITCHEN SINK • ti I 1 LAVATORY �f I 11 11 __ - 1_ - - _._.. 1 ,. I ROOF DRAIN I _ _ ._ 1 _ _ v _ . . 11 - - ...1 SHOWER STALL It_ _ __ ... L SERVICE/MOP SINK _ __ -- _ H _ _11 �. TOILET I I ,_._ __ E URINAL �a WASHING MACHINE CONNECTION _ t _._ 11 . ._II E I. 1 . 11 I . .1 WATER HEATER ALL TYPES 1 H . J ��._. I WATER PIPING ..,. , _. OTHER _1] _ I �. s ! .. _1 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 ji OTHER TYPE OF INDEMNITY Li BOND Ej 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 e a a urat best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c plia I e th Pert' nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. // �/ �— PLUMBER'S NAME Keith J. Farnham LICENSE# �11601 SIGNATURE MP0 JP ill CORPORATION 0# 3698C PARTNERSHIPU# LLC©# _ COMPANY NAME South Shore Heating Cooling, ADDRESS 57 Whites Path CITY South Yarmouth STATE MA I ZIP 02664 TEL 508-398-6901 I FAX 508-760-2681 CELL EMAIL info@southshoreheatingcooling.com U el .1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :"1'i CITY Yarmouth Port MA DATE 9/12/19 PERMIT OPP -� -'00/S 6? '-r JOBSITE ADDRESS 120 Wianno Rd OWNER'S NAME Amy Naas GOWNER ADDRESS 120 Wianno Rd I TEL 508-362-4424 FAX L TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL i11 PRINT CLEARLY NEW: m_ RENOVATION: . REPLACEMENT:LI PLANS SUBMITTED: YES Ej NO APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER '1:. { ._.... -__ ._ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I ! j i i' DRYER �_. FIREPLACE 1 I I i I FRYOLATOR I n,... _.„ FURNACE I ._w__ 11.11111111111110111L 1 IOW I .. , :.. POOL GRILLE INFRARED HEATER I OVEN 1 - 1 tl I -i• •- IW WATER HEATER 1 I I OTHER MKS- 1111 i I I . _„ _v„ __ .„ _ Pe _� _ _ _ _ __ ._. . . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L NO 0 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 Lj 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 D AGENT 1,_ 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 an acc ate th st o m knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp. e wi all t prov' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham 1LICENSE#I 11601 SIGNATURE - MP MGF D JP JGF[1 LPGI _,1 CORPORATION I ',Pt 3698C PARTNERSHIP # LLC ... .# COMPANY NAME: South Shore Heating&Cooling, ADDRESS 57 White's Path CITY South Yarmouth STATEril ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL] EMAIL info@southshoreheatingcooling.com •G o w c5 � � J