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HomeMy WebLinkAboutP-20-2711 sr;rt ,t10 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK --,�,� 0 CITY Yarmouth Port MA DATE 10/31/19 PERMIT#I, A/9-12*i 7 t7// �~ JOBSITE ADDRESS 8 Lucerne Dr. OWNER'S NAME Mike Suchenicz POWNER ADDRESS 8 Lucerne Dr. TEL 508-362-8947 FAX L TYPE OR OCCUPANCY TYPE COMMERCIAL ED EDUCATIONAL E RESIDENTIAL D PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES CI NO FIXTURES-1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM , DEDICATED GAS/OIL/SAND SYSTEM _ 5 1 DEDICATED GREASE SYSTEM _ DEDICATED FLOOR DRAIN DRAININTERCEPTOR(INTERIOR) , —, KITCHEN SINK ROOF '!SERVICE/MOP SINK TOILET , WATER HEATER ALL TYPES in .unon....noinn...illigni WATER PIPING I OTHER ' _, . _ _ , ( _, INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO E IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND 0 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 true an cc est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp" ' all Pertine rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _Keith J. arnham __ µ µ __ILICENSE# ,11601m SIGNATURE \F MPEI JP CORPORATION©# 3698C_d PARTNERSHIP0# I LLCEl# _ _I 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 tt. _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ir I.__-e `': .114s 4 CITY Iyarmouth Port MA DATE 10/31/2019 PERMIT#/1-f J 1r7/l JOBSITE ADDRESS 8 Lucerne Dr OWNER'S NAME Mike Suchenicz CT OWNER ADDRESS 8 Lucerne Dr. TEL 508-362-8947 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL L EDUCATIONAL Li RESIDENTIAL D PRINT CLEARLY NEW:LIRENOVATION:L REPLACEMENT:El PLANS SUBMITTED: YES E, NO 0 APPLIANCES Z FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER I ,�' CONVERSION BURNER •e • DRYER FIREPLACE GENERATOR . �.. I IF-7 1 3 ,, , GRILLE �! —ice MI MI MN LABORATORY COCKS MAKEUP AIR UNIT 1 , OVEN ! , I s I i 1 • POOL HEATER i O•ROOF TOP UNIT ingI Tu EN Si TT UNVENTED ROOM HEATER WATER HEATER m OTHER I ' w ! I I ,_ `' a ___ __ _ .rv_ . __ ___ _.. _ ___..,..___ i it III INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E,NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -'j OTHER TYPE INDEMNITY 1 BOND I_.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: OWNER L I AGENT Fl 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 curat st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli " all Pertinen provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham I LICENSE#1 11601 SIGNAT MP MGF ,,,„j JP , JGF LPGI I_____I CORPORATION _�1# 3698C 1 PARTNERSHIP # LLC 71# COMPANY NAME: South Shore Heating&Cooling j ADDRESS 57 White's Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508 760 2681 j CELL ,EMAIL info@southshoreheatingcooling.com