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Home My WebLink AboutBLDP-19-001407 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ;v $W-.7=—=- %.m;,m! CITY west yarmouth MA DATE 8/20/2018 PERMIT# / -P<P�9' VI yO 7 JOBSITE ADDRESS 5 glenwood st OWNER'S NAME jean wackrow POWNER ADDRESS TEL 7370158 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL I I EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 2k' In— DEDICATED SPECIAL WASTE SYSTEM U a I IL DEDICATED GAS/OIUSAND SYSTEM 1� _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM II l _ _ 1 DEDICATED WATER RECYCLE SYSTEM —� DISHWASHER I DRINKING FOUNTAIN I I FOOD DISPOSER - _ J iI FLOOR/AREA DRAIN U I INTERCEPTOR(INTERIOR) --7f IPrlIMIJIIMMI, -7 ,KITCHEN SINK r 7, LAVATORY w 1 ROOF DRAIN Ell=II 1 —EMI= NM SHOWER STALL I�I ( I I I SERVICE/MOP SINK J TOILET I j k. URINAL L I J I� WASHING MACHINE CONNECTION L _ il IL r-J_ Ji l" WATER HEATER ALL TYPES © r { 1111111114111 II WATER PIPING lariMINIIFPI IMIIIIIMMIll OTHER I—��fir II�II I1II — IMIllir!il 1p—u-- —.I I. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i NO n IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY H BOND U 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tr nd acdurat o.th be est of my nowledge and that all plumbing work and installations performed under the permit issued for this application will be in co fiance al ertine t rovisi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. % 1 7 PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SIG ATURE MP i JP❑ CORPORATION❑# 3698C PARTNERSHIP❑#1-671 LLC I I# COMPANY NAME South Shore Heating&Cooling,Inc. ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL