Loading...
HomeMy WebLinkAboutBLDP&G-18-006088f . ,,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Wig CITY south yarmouth MA DATE 4/5/2018 PERMIT# p->Y-ad crf4 ��J JOBSITE ADDRESS 148 pine grove rd OWNER'S NAME suzanne hall POWNER ADDRESS TEL 6035604002 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL © RESIDENTIAL❑ PRINT CLEARLY NEW: © RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NOD FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( -- it - I CROSS CONNECTION DEVICE -. ,. i 7--- DEDICATED SPECIAL WASTE SYSTEM t i .- -1` DEDICATED GAS/OIUSAND SYSTEM _ J DEDICATED GREASE SYSTEM —I DEDICATED GRAY WATER SYSTEM _ r_ _ MII -1. LM DEDICATED WATER RECYCLE SYSTEM1111111!1171. DISHWASHERMIN I' I I DRINKING FOUNTAIN U FOOD DISPOSER II FLOOR A � �- 7—� INTERCEPTOR(INTERIOR) Ir l IL_I KITCHEN SINK � ii�� __ -I' _ i LAVATORY Mil ROOF DRAIN -_ — SHOWER STALL --IF — -i SERVICE/MOP SINK 11---- - Nil iMi TOILET - [, I! URINAL l� WASHING MACHINE CONNECTION , ' 7,---� Uni 77 WATER HEATER ALL TYPES x 1--- �' r._ __ WATER PIPING OTHERMIIIIIIMINIM- r 7 MEMIIIIIIIIIIM INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 10 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY- OTHER TYPE OF INDEMNITY 0 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. CHECK ONE ONLY: OWNER (.., . AGENT Li 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. �\ n PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SI ATURE - — MPQ JP❑ CORPORATIOND# 3698C IPARTNERSHIPO# JLLC0# 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 J EMAIL p 1 t.r W L\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,--•_,,,,„.:- 7.4 am- CITY south yarmouth I MA DATE[4/5/2018 1 PERMIT#/3L0/8-or Egg JOBSITE ADDRESS 148 pine grove rd I OWNER'S NAME [suzanne hall 1 GOWNER ADDRESS I TEL 6035604002 IFAX I TYPE OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL El CLEARLY NEW: RENOVATION: REPLACEMENT: v 1 PLANS SUBMITTED: YES El NOL J APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I � .r BOOSTER ' I CONVERSION BURNER ��_�� COOK STOVE IIIIIIIIIII ME DIRECT VENT HEATER 1 DRYER FIREPLACE I FRYOLATOR NM —M11111.111111 FURNACEI� � GENERATOR =WI. U ME RI HEATER [ INFRAREDEll ill■■ ■■■ LABORATORY MAKEUP AIR UNIT OCKS ■■ ■■■■■� ■III! OVEN IM1 Ii POOL HEATER air Mi- 1II SPACE ROOF TOP UNIT -r-- TEST UNIT HEATER AIM MIN= IMIIIII NW UNVENTED ROOM HEATER OM MM.. —1 WATER HEATER ���� ����i111111111111111111111� OTHER Ella■■ III -._ MAN 1111111 In all IM" It INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 11 OTHER TYPE INDEMNITY Li 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. CHECK ONE ONLY: OWNER 1 AGENT LI 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 provi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. '� PLUMBER-GASFITTER NAME Keith J.Famham I LICENSE#111601 NA URE MP ' I MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION Q# 3698C I PARTNERSHIP❑# LLC❑# COMPANY NAME: South Shore Heating&Cooling,Inc ADDRESS 1 57 White's Path CITY South Yarmouth I STATE MA ZIP LOZ64 JTEL L508-398-6901 J FAX 508-760-2681 !CELL EMAIL