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HomeMy WebLinkAboutBLDP-20-002534 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY yarmouthport MA DATE 10/16/2019 PERMIT# /4 1'AO i 02 Say • JOBSITE ADDRESS 134 water st OWNER'S NAME William staudenmayer OWNER ADDRESS TEL 3671183 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL O EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES Ej NOQ FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUBL...,.,,,.,,. CROSS CONNECTION DEVICE x ll .....,. ,,.,,.,,,.,.,,,,. ........,...,.,.. �_.� ..., _,_,.... L................._.. .....,.,....,..,,,,, DEDICATED SPECIAL WASTE SYSTEM It....._. ...-IL, ........,.,.,.,...... ,,,,,.,,,,,,r.,.. ..,.... .......; _.�.�..._,,....,. DEDICATED GAS/OIL/SAND SYSTEM i , DEDICATED GREASE SYSTEM 11111111111111110111110111111 SYSTEM INF DEDICATED WATER RECYC E � SYSTEM 0 MEW 111111 MIK� DISHWASHER11111111111111111111 1111111111111111.1111'��� .,�',11111111111111,I_1_'111111 DRINKING FOUNTAIN1 1111111111111111111111.1111111111111111111111111 FOOD IM1111111111111111111111111111111111111M111111111.111101 FLOOR I AREA DRAIN AM=11111111111111111 NM ME INTERCEPTOR(INTERIOR) 1111111111111111111111111111111101111111111W11111111111111101111111111111 1111111.111111111111111111111111111110111 KITCHEN SINK MINIM,NM MEW 1111.1111111111 111111111111111.11 MIN'Int 11111.1111111011 LAVATORY 1111111M1111lFIIIIIII1M111111111111111111FWW111111111111111lIlF ROOF DRAIN 111111111111111111111111.1111111F11111111111111111111W1111111111111111111111111111111111111111111111111 SHOWER STALL M111111111111'11 111111 111111.111111111, SERVICE I MOP SINK TOILET ,_,,_.,._,,.,,,, ....._.,..�.,.,.. URINAL WASHINGMACHINE CONNECTION._,...,,_,,,, ,,,,,,,,,,,,,,,_._,f_.,, .........,. ...,,,,..,,,.,......,.L..................... ,....,..._,.,.,,.,,,, .,._-...,_,..._„ ,,,_..--......,,.., ....,.,.....,....,...,J..,,.,,.,.,,.,..,.,..J._,,,..,,,_,,.,..,,, ],,,,,.,,....,.,,.,,.,, WATERHEATER ALL TYPES U ... .. ...................... ...................... .....................J.-,,,,,,.....,..,....I....._,.,.,,,,.,.... ...,..,......_...,.., ,.......,........L.,,....,._.__....1 WATER PIPING t t �....._. .w.__..,-_._ OTHER11 II.. ..,- IL. .............. .......... L,..,...,.,.....- IL ..,....._...... 1 It,__..,... ,.au1l................1, ,-. , It E. .......... ................._.. .� .,,__,.1..,_....... ,,.,.._,.,.,,.,,,, ,.,._.............,. ..,...,.,,_,_. ........,.,.,..11..,,,..._......... f....,__......,,,,.1L,,�..,,.,...11.,............. ,_ . I ,, 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 0 OTHER TYPE OF INDEMNITY 0 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 © AGENT LI SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t nd ac rat to est otTny knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co ance al e ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Farnham �.a��.,....,.,. LICENSE# 11601 I SIGNATURE MPO JP O CORPORATION0# 3698CPARTNERSHIPO# LLCO#.........__._._________..._...� 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 I CELL EMAIL infoOa southshoreheatincoolin9.com