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HomeMy WebLinkAboutBLDP&G-22-006288 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 'YARMOUTH MA DATE 5/2/22 PERMIT# BLDP-22-006288 JOBSITE ADDRESS 1300 BUCK ISLAND RD UNIT 4C OWNER'S NAME GOODWIN GEORGE W P OWNER ADDRESS GOODWIN GRETCHEN M 300 BUCK ISLAND RD UNIT 4C WEST YARMOUTH,MA TEL 02673 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL al PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—. 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 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. 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 and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 'Richard Whiteside LICENSE 16850 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME Murphy's Services,Inc ADDRESS 34 White's Path CITY 'South Yarmouth STATE 'MA ZIP 02664 TEL 5087601660 FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - r CITY 'YARMOUTH t, I MA DATE (May 02,2022 'PERMIT# BLDP-22-006288 JOBSITE ADDRESS 1300 BUCK ISLAND RD UNIT 4C I OWNER'S NAME 'GOODWIN GEORGE W I G OWNER ADDRESS GOODWIN GRETCHEN M 300 BUCK ISLAND RD UNIT 4C WEST YARMOUTH MA 02673 TYPE OR OCCUPANCY TYPE I TELI PRINT COMMERCIAL❑ RESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES ❑ NO El FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 BOILER 8 9 10 11 12 13 14 BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER • DRYER FIREPLACE • FRYOLATOR FURNACE GENERATOR • GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER • ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El 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. 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 and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 'Richard Whiteside I LICENSE# 115850 MP GU MGF 0 JP 0 JGF 0 LPG' El CORPORATION 0#�� I SIGNATURE PARTNERSHIP 0# LLC ❑#� COMPANY NAME: Murphy's Services,Inc ADDRESS. 211=1121 CITY South Yarmouth STATE MA ZIP 02664 TEL 5087601660 FAX CELL EMAIL