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HomeMy WebLinkAboutBLDP&G-22-006468 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK p: z CITY YARMOUTH MA DATE 5/10/22 PERMIT# BLDP-22-006468 j JOBSITE ADDRESS 33 RUNE STONE RD OWNER'S NAME CRAWFORD JULIANNE P OWNER ADDRESS 33 RUNE STONE RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El 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 0 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. 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 keith farnham LICENSE 141601 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME south shore heating&cooling ADDRESS 57 whites path CITY south yarmouth STATE MA ZIP 02664 TEL 5083986901 FAX I I CELL EMAIL S310N M3IA321 NYld #11W113d $S33d 3H1 Stl 3AM3S N011Y3 lddY SIHL oN sa i S3,LONI NOI103dSNII IVt1II3 VINO 3Sf1 3314301103 MO'IIH S31OAI PIOI1D3dSNII ONIRI Irld H9f1O1I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 10,2022 PERMIT# BLDP-22-006468 JOBSITE ADDRESS 33 RUNE STONE RD OWNER'S NAME CRAWFORD JULIANNE G OWNER ADDRESS 33 RUNE STONE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO El FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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-GASFITTER NAME keith farnham LICENSE# 11601 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI El CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: south shore heating&cooling ADDRESS. 57 whites path, CITY south yarmouth STATE MA ZIP 02664 TEL 5083986901 FAX CELL EMAIL S31ON M2IA I NVld #1I V d $ 333 lJL l d 3Hl SV S3A L S NOLLVOIlddV SIHl ON se,A S310N NOI103dSNI 1VNId AlNO 3Sfl IO103dSNI 2IO 13OVd SIHl S31ON NOI103dSNI SVO Enna!I