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HomeMy WebLinkAboutBLDP&G-21-005924 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/13/21 PERMIT# BLDP-21-005924 JOBSITE ADDRESS 10&12 WAMPANOAG RD OWNER'S NAME COADY ELIZABETH A P OWNER ADDRESS 19 PAINE RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El 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 El NO ❑ 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 El 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 El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SOUTH SHORE HEATING& ADDRESS 57 White's Path COOLING CITY South Yarmouth STATE MA ZIP 02664 TEL FAX I I CELL 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 S PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � �/ %- 1°'- CITY a ►t MA DATE ./Z "' PERMIT# . JOBSITE ADDRESSD 003 rat OWNERS NAME ` Ct�44142:23 (on,L., .._ 1 S •AtarmooitL. 1 1 Li,- 3 CDS- Ax P2- OWNER ADDRESS � Rur � �� TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 1] RESIDENTIAL Er.--- PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: % PLANS SUBMITTED: YES ❑ NO a-- FIXTURES Z FLOOR--, 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 SYSTEM DISHWASHER _ _ DRINKING FOUNTAIN . FOOD DISPOSER -I _ _ FLOOR!AREA DRAIN . INTERCEPTOR (INTERIOR) _ _ KITCHEN SINK LAVATORY ROOF DRAIN . SHOWER STALL _ SERVICE 1 MOP SINK - TOILET - URINAL . WASHING MACHINE CONNECTION . WATER HEATER ALL TYPES ! - - a WATER PIPING OTHER . L INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ['i NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er OTHER TYPE OF INDEMNITY ❑ BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Law: :)d that my signature on this permit application waives this requirement. ,� ,/. tko CHECK ONE ONLY: OWNER ❑ AGENT 1( ,t (Jc. AGENT Sl GNATURE i' OW OR I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac rate . the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ail '"-rti �sio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,,- V _.......---- PLUMBER'S NAME ( 112G-4-tilc• .re"-" 1A '`"A LICENSE # l ((COI SI ATURE MP JP ❑ CORPORATION Er# ,3i043 PARTNERSHIP ❑ # LLC.❑ # ��;c �Z>�'L� � tjAAESS 6-1 �&( 4�is QtLkL MPAN NAME CITY { ` (, .., STATE Ftek d ZIP b Z Li TEL t O ( FAX CELL EMAIL I n 6(t1e h C 4 ',i rii;25 ' c MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r V` , CITY YARMOUTH MA DATE April 13,2021 PERMIT# BLDP-21-005924 hf r1'$ JOBSITE ADDRESS 10&12 WAMPANOAG RD OWNERS NAME COADY ELIZABETH A G OWNER ADDRESS 19 PAINE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO 0 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 I 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 Li 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 1 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 0 JGF❑ LPGI 0 CORPORATION 0#, PARTNERSHIP ❑# LLC ❑# COMPANY NAME: SOUTH SHORE HEATING&COOLING ADDRESS. 57 White's Path, CITY South Yarmouth STATE MA ZIP 102664 I TEL FAX I I CELL I I EMAIL info(a)southshoreheatingcoolinq.com 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 MASSACHUSEITS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK flIF:1.3' CITY:C1'f i11'01 irv9 CLA MA. DATE -aV Z-( PERMIT# JOBSITE ADDRESS: �O,WNNEER'S NAME: �S C Q- - GOWNER ADDRESS: el • I� 7�EL: 1 114-YOS' 2. TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0' PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:.2 PLANS SUBMITTED: YES❑ NO 2' APPLIANCES FLOOR-4 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 .m GRILLE j INFRARED HEATER _ I LABORATORY COCK _ . MAKEUP AIR UNIT OVEN POOL HEATER ROOM f SPACE HEATER • ROOF TOP UNIT ' TEST ;Z UNIT HEATER i,U UNVENTED ROOM HEATER WATER HEATER j INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El-NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY Er OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I.m aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass chusetts General Laws,a t/that my signature on this permit application waives this requirement. U LQ%)L `A 14f. tis( 'f.( CHECK ONE ONLY: OWNER ❑ AGENT la-- SIGNATURE OF OWNER OR At NT 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 plian•.- ,th ' nt provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. P UMBER(G�ASFITTERNAME: _ .�h Ja �Nh (�LII SSE# < « SIGN' 12R `_ COMPANY NAME. t' �`C( AdD1�e .15 4 `4-vs + x_4-! CITY: STATEA• ZIP: C. `-t FAX: TEL: d1 CELL: EMAIL: trlft i-k.5 YIP c.fc esCn hJ ,.�� v--( MASTER Lam' JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 21 6�'e PARTNERSHIP❑# Li C❑# E 172 4-74. ADA2c-ss: