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HomeMy WebLinkAboutBLDP&G-18-006364 t:-4--- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK it_ii= -- :•'l-14= CITY west yarmouth J MA DATE 4/29/2018 PERMIT# �"�� '` JOBSITE ADDRESS 41 mill pond rd J OWNER'S NAME martin tanquay POWNER ADDRESS I , TEL 5087377983 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 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 __ — •-- 7 CROSS CONNECTION DEVICE Ili r - l DEDICATED SPECIAL WASTE SYSTEM 11111111111111..111111111. MI MO DEDICATED GAS/OIL/SAND SYSTEM INN__11.1 MIME MIT 1ML M11111111111 DEDICATED GREASE SYSTEM SE_—_I I IIIII . DEDICATED GRAY WATER SYSTEM M JIMI DEDICATED WATER RECYCLE SYSTEM 1:11111111===t—n- ._ _____,. DISHWASHER - I(��_I�jI __..IL �� INTERCEPTORDRINKING FOUNTAIN mi ,,____ ____I_______,L_ 'L_ E FOOD DISPOSER FLOOR/AREA DRAIN ..r;. ___, '• KITC LAVATORY . ROOF DRAIN _1 — �I IIIIIII IIIIIIIINI —1�_ SHOWER STALL TOILET ' - ----pii, r( iIWASHING MACHINE CONNECTION MS - r- --In 1,,.... �prao1 1 WATER HEATER ALL TYPES ©'am iit i i*12.`W rElt;I IMF PIPING f EM r (. OTHER a I '' 1i1 o ( I _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[77 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. 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 d accurat -best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp. ce;wit I Pertin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - • .etG PLUMBER'S NAME Leith J. Farnham LICENSE# 11601 SIGNAT E V MP JP CORPORATION❑# 3698C PARTNERSHIP❑# LLC # 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 _ s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -"ki=�Itt-77- CITY west yarmouth MA DATE 4/29/2018 PERMIT#/ A/t 'c ,y JOBSITE ADDRESS 41 mill pond rd OWNER'S NAME martin tanquay GOWNER ADDRESS TEL 5087377983 FAX TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:_ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 Q 7 1--per-f - ,' ( - 1 1 I BOOSTER 1— 1r IF '-1 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ DRYER FIREPLACE lia , FRYOLATOR FURNACEIll _ _ GENERATOR GRILLE INFRARED HEATER __ LABORATORY COCKS MAKEUP AIR UNIT _ OVEN POOL HEATER num ,ROOM/SPACE HEATER __r I 1 ROOF TOP UNIT pur. TEST UNIT HEATER �� UNVENTED ROOM HEATER WATER HEATER x p• r '1„ OTHER =.Y iL� ',� ME i II . _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE 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. 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 true a9d accur e bes f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliarfce with II a nent ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i ,/ 1 * .c.Cl -_ PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 /' SIGNATURE MP i MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHKO# LLC❑# COMPANY NAME:[South Shore Heating&Cooling,Inc ADDRESS,57 White's Path CITY SouthYarmouth J STATE MA ZIPE2664 TEL 508-398-6901 FAX,508-760-2681 CELL ___!EMAILr_