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Home My WebLink AboutBLDP&G-19-05937 , *CM ADQ_ ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK "1° 19- CITY south yarmouth MA DATE 4/5/2019 PERMIT#,OP '-00 .M7 ,t JOBSITE ADDRESS 70 poinsetta dr OWNER'S NAME eleanor quinn POWNER ADDRESS TEL 3946745 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB U U I U U U U CROSS CONNECTION DEVICE ( f Q DEDICATED SPECIAL WASTE SYSTEM U U I V ! U U U 11 DEDICATED GAS/OIUSAND SYSTEM U U 1 1 J U U U DEDICATED GREASE SYSTEM U I i U U I U DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM I DISHWASHER j 1 i 1 I I II DRINKING FOUNTAIN 1 r I 1 I 1I 1 ir FOOD DISPOSER l I I I I- FLOOR/AREA DRAIN I l I INTERCEPTOR(INTERIOR) 1 1 1 I, I 1 KITCHEN SINK 1 LAVATORY II 1 I ROOF DRAIN r 7 r 1 1 1 SHOWER STALL U U U I U SERVICE/MOP SINK TOILET U I O URINAL U U U U U 1 WASHING MACHINE CONNECTION UI U U 1 1' WATER HEATER ALL TYPES x U U i IJ WATER PIPING U U U U U OTHER I U 1 I U U ll li 1U I 1 1 _U U ll U 1 U u l l U INSURANCE COVERA(�iE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ILI OTHER TYPE OF INDEMNITY ❑ 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: WNER ❑ 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 acc . to t he of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp• ce wi all P it vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SIGNATURE MP❑ JPE CORPORATION 0# 3698C PARTNERSHIP❑# LLC❑# COMPANY NAME South Shore Heating&Cooling, ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL Lijoro e$nl+h Sh11Y-r,her-tih c op 1 i 1--)3 . CUB Lf ff .'^ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -1a,-/ CITY south yarmouth —1 MA DATE 4/5/2019 PERMIT# /tl-I9/ --€t' 7 ' 7 JOBSITE ADDRESS 70 poinsetta dr OWNER'S NAME eleanor quinn GOWNER ADDRESS TEL 3946745 FAX TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:h PLANS SUBMITTED: YES NOD APPLIANCES Z FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i ! BOOSTER M IIIIIIIIIII 1111111 MI Ell MEI,Mill- -i[ CONVERSION BURNER COOK STOVE Mil ll it_ i _ I DIRECT VENT HEATER M' ! MIMI�ON 1 _ I[IIJ DRYER IMIM-�MMIIm FIREPLACE II �--- .I T_ _ II II FRYOLATOR lannina- r I _ FURNACE I I � GENERATOR MIME.IMIMINI MI MI M = IEM= GRILLE �ra� � INFRARED RYATER �i, r.,7 � , 717R1 MA LABO P AIR UNIT OCKS �I OVEN Mall. ! I '11 POOL HEATER '': n , if ROOM/SPACE HEATER ROOF TOP UNIT WM= Ill 1.==e, rma TEST UNIT HEATER Billnallilli,111,Mil,M,li. IMIiI UNVENTED ROOM HEATER IM MI 1111.11MIM MN M M M MIIMIlli WATER HEATER !© MMI M'IWCII _ OTHER MINIM 1111111IIM-M EOM I•IiiiI_r- Mr 1111111111. !—MIII I— MI I-- il_I' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES U NO n I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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: OW ER ❑ 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 and curs to st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian t i vi n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 SIG AT MP I I MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHIP❑# LLC❑# COMPANY NAME: South Shore Heating&Cooling, ADDRESS 57 White's Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL EMAIL r.