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HomeMy WebLinkAboutBLDP&G-21-005965 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ; ; ; CITY YARMOUTH MA DATE 4/15/21 PERMIT# BLDP-21-005965 i5 (®:ism 1E7°" JOBSITE ADDRESS 25 FINCH LN OWNER'S NAME MASON KAREN M P OWNER ADDRESS 25 FINCH LANE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES El NO❑ FIXTURES FLOORS-4 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❑ 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#1601 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SOUTH SHORE HEATING& ADDRESS 57 White's Path COOLING CITY South Yarmouth STATE 'MA I ZIP 02664 TEL FAX CELL 7 EMAIL info@southshoreheatingcooling.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t,^ � CITY lWa 'in MA DATE iq /4L /2Oc _( PERMIT# aL t)(1.- .1( --°° 5 i 6, r \z-7,-- . JOBSITE RESS 25 "FL C,I--1. LaKie, OWNER'S NAME 1'6 P ZA-.I Ce 9)4_3 OWNER ADDRESS TEaE' D� ) AX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL ff-' PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO [ FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIL/SAND SYSTEM DEDICATED GREASE SYSTEM _ . DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ _ DISHWASHER . DRINKING FOUNTAIN . FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR (INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN _ SHOWER STALL _ SERVICE I MOP SINK , TOILET _ URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I _ WATER PIPING OTHER . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Z NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Zr 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 i ,► my signature on this permit application waives this requirement. l'6,r(OA/LCA, 4 r c(PA4,/ CHECK ONE ONLY: OWNER ❑ AGENT fr SIGNATURE OF OWN R OR A.VENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccura- to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian 'th a P ' roves n of the Massachusetts State Plumbing ode and Chapter 142 of the General Laws. j-- PLUMBER'S NAME 1,-6e4 `iAl. j-: -604( 2- 't.1-- LICENSE# t ( wbi • GNATURE MP 11 JP El CORPORATION L'J r A`'l8 PARTNERSHIP ❑ # LLC ❑# ��II �IrI.�vw� '� �"w Y ea t C�bDDRES'S 504 eSC����CM -et_S-V- CITY 4 441 STATE HA. ZIP Q2LrQU TEL _._ --ter-(POI FAX CELL EMAIL I iI P-SW* . N r rt 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k.,„ s —i7-111,7I iR CITY YARMOUTH MA DATE April 15,2021 PERMIT# BLDP-21-005965 _e ti JOBSITE ADDRESS 25 FINCH LN OWNERS NAME MASON KAREN M G OWNER ADDRESS 25 FINCH LANE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 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 0 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 0 MGF 0 JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: SOUTH SHORE HEATING&COOLING ADDRESS. 57 White's Path, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL infoI southshoreheatingcoolinq.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMR ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES 1;J` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Qt.= i=._`' CITY: I4 yA MA. DATE 14-1SLG 2t c LJ PERMIT# O v 1 JOBSITE ADDRE : Z5'F:'Y I‘ate. O EER'S NAME: (, v CCM_ > 50:4') GOWNER ADDRESS: C ^t LC ET L?� S 3 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL L— PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0' PLANS SUBMI I i bD: YES❑ NO EY-- APPLIANCES-1 FLOOR-0 Bsmt 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 VI INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT r OVEN POOL HEATER ROOM(SPACE HEATER • _ -a ROOF TOP UNIT fi TEST UNIT HEATER i•U UNVENTED ROOM HEATER WATER HEATER i INSURANCE COVERAGE � I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES tJ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ff1f OTHER TYPE 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 Mas achusetts General La d that my signature on this permit application waives this requirement. �,s� -L CHECK ONE ONLY: OWNER ❑ AGENT E SI NATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(cr 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 I mpll with 'vent • . provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /-� PLUMBS SFI ER NAM: 4 11 � Y"111, LICENSE# 1 1 �C�/l^ CO E.: 1 6,12XL. it ci i ." 4DDR SS: h t ._ CITY: • ,` Y1ti1( - STATE: •WA.• ZIP: C7i( FAX: TEL: V 6.g01 CELL: EMAIL: i MASTER 2r JOJRNEYMAN❑ LP INSTALLER❑ CORPORATION u#- 6C6 PARTNERSHIP❑# LC❑ E 1Y1!3/L ADivz.c-.Ss ' �_t),—FU 1 �1Or { —L i.on I N5 ' CEO