HomeMy WebLinkAboutBLDP-20-000585 [---ax MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Vap.... CITY south yarmouthMA DATE 7/23/2019 PERMIT#�/ 'c Or
__5'` JOBSITE ADDRESS 39 four season rd OWNER'S NAME dorothy scarlett
POWNER ADDRESS TEL 3985372 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
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CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR—+ BSM 1 2 3 J 4 5 6 7 8 9 10 11 12 13 14
BATHTUB J i I I11 11 11
I [I
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM J 1 U U
,
DEDICATED GAS/OIUSAND SYSTEM Ii I [ i - 1 , _I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM I J I. I,
D DEDISHICATED
WATER RECYCLE SYSTEM I l ,,- -� I
DRINKING FOUNTAIN rf U F I — ( _ '
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) U II U i 1
KITCHEN SINK 11 U
LAVATORY Ii U U 11 U
ROOF DRAIN I) I Jl U U I
SHOWER STALL U U U U U
SERVICE/MOP SINK JJ U U U U
TOILET I I V U
URINAL U jJ U U I U
WASHING MACHINE CONNECTION 11 1 I U U 11 I U
WATER HEATER ALL TYPES x I I O I I
WATER PIPING J 11 1 U U I U 1 11 1, .
OTHER _ I U U U U
1 11 I U U ll 1 11 U
1 U U II It I
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❑ OTHER TYPE OF INDEMNITY ❑ 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 ❑
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 a acc o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in c lia e wi I Perrne provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1
PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 ! ' SIGNATURE
MP❑ JP El CORPORATION❑# 3698C PARTNERSHIP❑#1ILLC❑#
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