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HomeMy WebLinkAboutBLDP&G-18-006643 , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ®gip CITY //I�-Cn7C9 �/ —1 MA DATE PERMIT# Q/-/g't�aci: JOBSITE ADDRESS CO C C vCS F7f lel.„ OWNER'S NAMEM, ✓A) L_/ i. ' , POWNER ADDRESS s.7 6,41-1_ TEL-2?g-Ess(/ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL_.,J EDUCATIONAL 0 RESIDENTIAL 0 PRINT f, / CLEARLY NEW:0 RENOVATION:© REPLACEMENT: PLANS SUBMITTED: YES 0 NO �Ll FIXTURES 1 FLOOR— 5 6 7 8 9 10 11 12 13 14 BATHTUB _TM Mimi CROSS CONNECTION DEVICE M� DEDICATED SPECIAL WASTE SYSTEM ! DEDICATED GAS/OIL/SAND SYSTEM MI DEDICATED GREASE SYSTEM —II _ ! 11111 _ EME11.11111111111011 DEDICATED GRAY WATER SYSTEM ( j Mill_®— _ DEDICATED WATER RECYCLE SYSTEM M PM _r- _MI— DRINKING DISHWASHER r— FOUNTAIN C IMMTIII FOOD DISPOSER IMMINIMIIIIIN MI 1 FLOOR/AREA DRAIN 1111.111 L' .1111 INTERCEPTOR(INTERIOR) I _ ��7— ® � KITCHEN SINK MOM LAVATORY 'IEIIIIIMMI MI ROOF DRAIN MIIMIIIIMANIMIN�MI � _ SHOWER STALL --II— �� 1 � SERVICE/MOP SINK ® _�I ' ® ` -I_ TOILET 1� �� I URINAL f ll_. _ WASHING MACHINE CONNECTION I ll I I 1--- WATER HEATER ALL TYPES IL_ I _-1I. -- Mil I WATER PIPING _ 111.1111 I111111111_ OTHER `I. EliallIMMUMNIUMNIMI...1111111111111111•111111111116.- E161I11 1 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 L BOND n 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 cc a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co II Pertin provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �I PLUMBER'S NAME Keith J.Farnham .LICENSE# 11601 SIGNATURE MPO JP.1 CORPORATION0# 3698C 'PARTNERSHIP pi LLCM# _ COMPANY NAME South Shore Heating&Cooling,Inc. 1 ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL r " ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK %.�b / CITY )/4J?17Q(4Zi. MA DATE :jam _l 61 PERMIT# ` �IZ (�(O1 JOBSITE ADDRESS 6 6 -fret f // OWNER'S NAME `4Z hA) L-i 7� OWNER ADDRESS G �' g% a C FAX„s' e y1I�-f'i'�,.f, TEL TEL S �{�-�c TYPE OR OCCUPANCY TYPE COMMERCIAL[D EDUCATIONAL El RESIDENTIAL I i I PRINT CLEARLY NEW:P RENOVATION:7 REPLACEMENT: PLANS SUBMITTED: YES J NO Igi APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 ! 7 8 9 10 11 12 13 14 BOILER -^ 11- BOOSTER F CONVERSION BURNER L. COOK STOVE L DIRECT VENT HEATER L - ___ _ _ DRYER r _ FIREPLACE FRYOLATOR I _ I _FURNACE _ GENERATOR GRILLE INFRARED HEATER 1- _ LABORATORY COCKS Fri _ MAKEUP AIR UNIT r— , OVEN 1 POOL HEATER ROOM/SPACE HEATER J ROOF TOP UNIT .:_._ TEST __ UNIT HEATER [ I UNVENTED ROOM HEATER J- WATER HEATER -- _-______ r ..`x. I OTHER I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _ _! OTHER TYPE INDEMNITY 7__1 1 BOND L. 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 [—I AGENT I_.._. 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 ac at e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp) e wi ent ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME[Keith J. Farnham LICENSE# 11601 SIGNATURE MP '_'I MGF'; 1 JP JGF LPGI CORPORATION #13698C PARTNERSHI # 1 LLC®# COMPANY NAME:;South Shore Heating&Cooling, Inc ADDRESS 57 White's Path 1 CITY South Yarmouth STATE FMA-ZIP E02664 y _ TEL 508-398-6901 FAX 508-760-2681 CELL �EMAILi wpu v ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES