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HomeMy WebLinkAboutBLDP&G-19-003325 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •yl, n4 CITY YARMOUTH MA DATE 11/30/18 PERMIT# BLDP-19-003325 II JOBSITE ADDRESS 26 BRAE BURN LN OWNER'S NAME WELDON PETER A P OWNER ADDRESS WELDON KATHLEEN A 26 BRAE BURN LN SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ 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 D 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. 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 Keith Farnham LICENSE fd601 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KEITH J FARNHAM ADDRESS 4 JUNIPER HILL RD CITY EAST SANDWICH STATE MA ZIP 025371036 TEL FAX CELL I EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES T -..,6 It' - 43C . t‘ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘T)=rim: —� - CITY S. Yarmouth- , ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, MA DATE Nov 19, 2018 � PERMIT # /34,0P-/9-6v --,.... , JOBSITE ADDRESS 26 Brae Burn Lane OWNER'S NAME Peter Weldon POWNER ADDRESS SAME TEL L5_087,258:003,0___j FAX`,,,,,,,_.,,,,,,,,, ,,,,,,,,,,.,,„I TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL U RESIDENTIAL ' PRINT CLEARLY NEW: ED RENOVATION: D REPLACEMENT: E' PLANS SUBMITTED: YES El NO FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB --__ _�, ME Mill CROSS CONNECTION DEVICE 11111 umgu.IIIIIIII 1 DEDICATED SPECIAL WASTE SYSTEM IIIIIIPIIIIIMIIIIIIIIIIIMIIIIIIMIIIIIIIIIMRIIIIIEIIIIEMIIIIMIIIIIIIIIIIIIIIIIIMIIIIF DEDICATED GAS/OIL/SAND SYSTEM MI MIN �IIIIIIII MIME IIIIIIIIIIIIIIIIIIII DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM IIIII; MN M III. DEDICATED WATER RECYCLE SYSTEM J,,,,,,,,,,,,,_.1I ...,.,,,,,,,.. J . „ „ I I I....,.....,.,,,,,,, DISHWASHER ,1 R 1 DRINKING FOUNTAIN 1 FOOD DISPOSER j ,,,,.....,, .,, ,,,,,,,,,.., .., .. u,.., FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) IIIIIIIIIIIIIIIIIIIIIIIIINIMNMIIIIINIIIIIIIMIIIII , ,,------- _ KITCHEN SINK Mini i inn ! 111111111 Inn 1 LAVATORY vu„,,,.u, ROOF DRAIN l SHOWER STALL SERVICE / MOP SINK _ �., ,.,�,u TOILET MI MI MI NM MIL.. ,'MI NM URINAL �I�I : NMI �I . ���M WASHING MACHINE CONNECTION 11111111 �� „., . . , f_. , WATER HEATER ALL TYPES 1 I .. WATER PIPING M';MI MN I,NMI Mt MI NNE MO OTHER MINI I,I111111h MI0111111111111111111111111, 111111111111111111111111111 • i ' 11 I► i I,.. I.. 1.. . f.--- L 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 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY (:HECKING.THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v 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 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 ac urat o o knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn nce w. h all rti ent provis, n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i SIG Keith J. Farnham : LICENSE # rim°, NATURE PLUMBER'S NAME a . .,,.: .....,,.�..,._,...._....,,..,a r MP LI JP ® CORPORATION U#I„3698C,,,.,,,.,,,,,,,,,,, PARTN ER SH I P Li#LZLI LC LJ#I,,,„______,I COMPANY NAME South Shore Heating & Coolin9 I ADDRESS 57 Whites Path a i CITY South Yarmouth STATE I MA ZIP 02664 TEL 508-398-6901 . .................. ..... I , FAX 508-760-2681 ' CELL EMAIL i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ; ) CITY YARMOUTH MA DATE November 30,201E PERMIT# BLDP-19-003325 JOBSITE ADDRESS 26 BRAE BURN LN OWNERS NAME WELDON PETER A G OWNER ADDRESS WELDON KATHLEEN A 26 BRAE BURN LN SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 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: INSIJRANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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-GASFITTER NAME Keith Farnham LICENSE# 11601 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KEITH J FARNHAM ADDRESS. 4 JUNIPER HILL RD, CITY EAST SANDWICH STATE MA ZIP 025371036 TEL FAX -I CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES , �' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK __, t-4,_� — y sr CITY S. Yarmouth ,.,.., MA N.,.„.7 ...7_,, DATELNov 19, 2018 IPERMIT # h/-� I S-0°3. 3 JOESITE ADDRESSF26 Brae Burn Lane OWNER'S NAME Fr-Deter Weldon GOWNER ADDRESS SAME TE 508-258-0030 !FAX TYPE OR OCCUPANCY TYPE COMMERCIALS ' .. EDUCATIONAL RESIDENTIALI PRINT CLEARLY NEVV: RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES ® NOE1 APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _, ,„,_,_it___,i„.., ...._; -.._______.-.._____=-1 BOOSTER L. 7�—,...... = ,� CONVERSION BURNER '` i COOK STOVE _ DIRECT VENT HEATER I— DRYER _ . _ — ..... ......... FIREPLACE .. ,,_ � 1 FRYOLATOR I ,, ., ,i = . ,.� .,,,,,,,,,,,,,,,,..' I igliiiiiiill FURNACE ....:. ,� ����� �,_�... '_ ,_,,,....,1 ,.,,.,,. _.11„.............,,. GENERATOR I GRILLE _ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT (i —OVEN I = MN POOL HEATER AIMANN ROOM / SPACE HEATER , N _IM �� J ROOF TOP UNIT TEST ,Inoungnownionimmonsinumm Mk IN VIM UNIT HEATER � I UNVENTED ROOM HEATER , — — - 1 . iiifte tomato: WATER HEATER 1 1 v OTHER 1 1 ' ....................1 II 1 . .. .., ,_. __—: ... ..r ......., writ,.,.,. .,ter,.,.,., .,errrwrrrtrn .,.rrrrrrwr,.,, , , � ! s I INSURANCE COVERAGE I have a current liabiliyinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO INDICATE T E C COVERAGE BY CHECK!NG THEAPPROPRIATE i Ir YOU CHECKED YES, PLEASE THE TYPE OF �.Cvcrta,.:� BOX BELOW LIABILITY INSURANCE POLICY 5 OTHER TYPE INDEMNITY J 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 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 a accur e to e y knowledge and that all plumbing we rk and installations performed under the permit issued for this application will be in compli with II P i n pr ision f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / 4- >l,../ ,,ett-ti., ( PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE # 11601 .rSIGNATURE f MP El MGF 71 JP JGF ^' LPG! L.Li CORPORATION # PARTNERSHIP # LLC #! COMPANY NAME: South Shore Heating & Cooling, ADDRESS , 57 White's Path .„„.„,,,,,, i CITY South Yarmouth STATE MA I ZIP 02664 TEL 508-398-6901 a FAX 508-760-2681 CELL ,,,,,..... ,,,,, .. „ . EMAIL a