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Home My WebLink AboutBLDP&G-21-007051 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM RMI #PLUMBING B WORK PE T CITY YARMOUTH MA DATE 617121 07051 �, _ _ OWNERS NAME BERLIN SUSAN P OWNER ADDRESS P 0 BOX 1.i_, JOBSITE ADDRESS 22 TRANQUIL TRAIL TEL '" 327 YARMOUTH PORT,MA 02675 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El CLEARLY NEW: 0 g 9 10 11 12 13 14 FIXTURES FLOORS 6�=====_-_=====Ell = CROSS CONNECTION DEVICE _=======____ = DEDICATED SPECIAL WASTE SYSTEM IIII DEDICATED GAS/OIL/SAND SYSTEM ___- ====_______ DEDICATED GREASE SYSTEM 11111111111111111111111 MI MI IIIII DEDICATED GRAY WATER SYSTEM ______ DEDICATED WATER RECYCLE SYSTE ___-___ DISHWASHER ___ _____ DRINKING FOUNTAIN _____ FOOD DISPOSER ____ ____ FLOOR/AREA DRAIN ____ EPTOR INTERIOR ra___ __INTE RC 11111.11 _--___ IIIIIIIIII LAVATORY Mil MI ________ _______ ROOF DRAIN _____________ SHOWER STALL SERVICE/MOP SINK _-_ ____-____ TOILET __ _ __-___=_______ WASHING MACHINE CONNECTION _ MI --___ R HEATER 1 __ ____ WATE ______ OTH OHEER DESCRIPTION: INSURANCE COVERAGE: YES El NO 0 I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does 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 all plu that allof the deinstallat installations performed under the submitted pe mot issued for this applicationng this n will l be in are with all accurate Pertinent provision on of the my knowledgeand that all plumbing work a Massachusetts State Plumbing Code and Chapter 142 of the General Laws. LICENS:#1601 SIGNATURE PLUMBER'S NAME LLC El# MP © JP 0 CORPORATION ❑# C� PARTNERSHIP ❑# COMPANY NAME South Shore Heating&Cooling ADDRESS 57 Whites path CITY South yarmouth STATE 331111111111111 ZIP 02664 TEL 5083986901 EMAIL FAX CELL ROUGH PLUMBING INSPECTI N N TES �' BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES I es No THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .;_=..i... ,_ q-ice'° � CITY YARMOUTH 1 MA DATE June 07, 2021 PERMIT # BLDP-21-007051 O�_ JOBSITE ADDRESS [22-TRANQUIL TRAIL - OWNER'S NAME BERLIN SUSAN G OWNER ADDRESS P 0 BOX 327 YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT: El PLANS SUBMITTED: YES ❑ NO ❑ 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 ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY BOND 0 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 0 MGF ❑ JP El JGF ❑ LPG' ❑ CORPORATION ❑ # PARTNERSHIP El # LLC ❑ # COMPANY NAME: South Shore Heating & Cooling ADDRESS. 57 Whites path, CITY South yarmouth STATE MA ZIP J02664 I TEL 15083986901 FAX CELL EMAIL I I 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