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Home My WebLink AboutBLDP&G-22-000522 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7/28/21 PERMIT# BLDP-22-000522 JOBSITE ADDRESS 46 CAPT WEILER RD OWNER'S NAME BROPHY JAMES E TRS P OWNER ADDRESS BROPHY MARCIA M TRS 46 CAPT WEILER RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 Ikeith farnham I LICENSEIMA SIGNATURE MP El JP El CORPORATION ❑# I I PARTNERSHIP El# I I LLC ❑# I COMPANY NAME (South Shore Heating&Cooling I ADDRESS 157,Whites Path CITY ISouth Yarmouth I STATE IMA I ZIP 102664 I TEL 15083986901 FAX I I CELL I I EMAIL I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Lilt � aCITY YARMOUTH MA DATE July 28, 2021 PERMIT# BLDP-22-000522 JOBSITE ADDRESS 46 CAPT WEILER RD OWNER'S NAME BROPHY JAMES E TRS G OWNER ADDRESS BROPHY MARCIA M TRS 46 CAPT WEILER RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Ei PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT: El PLANS SUBMITTED: YES El NO El 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 El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 # IMA I SIGNATURE MP ❑ MGF El JP El JGF El LPG' ❑ CORPORATION 0 # PARTNERSHIP 0 # LLC El # COMPANY NAME: South Shore Heating & Cooling ADDRESS. 57, Whites Path, CITY ISouth Yarmouth I STATE MA ZIP 102664 I TEL 5083986901 FAX 1 I CELL I I EMAIL S310N M31A3b NVId #11W213d $ 33d ❑ ❑ 11Wa3d 3H1 SV S3AH3S NOIlV0IlddV SIH1 ON SOA S310N NOI103dSNI 1VNId AINO 3Sfl H0103dSNI 210d 30Vd SIHL S310N N01103dSNI SV`J HOfON