The URL can be used to link to this page

Home My WebLink AboutBLDP&G-19-006740 A. ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • .Lei=54 CITY S.Yarmouth MA DATE 5/17/19 PERMIT#Al-i9 4 7 E JOBSITE ADDRESS 36 Shoreside Dr. OWNER'S NAME Joseph Pandolfo POWNER ADDRESS 3 Meadowcroft Rd., Burlington,MA 01803 TEL 617-908-1227 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:Li REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOE FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE IMF 1 ,_r r— I 1.111 ' DEDICATED SPECIAL WASTE SYSTEM illl,f=r11 IMillil! _ DEDICATED GAS/OIL/SAND SYSTEM !p DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER p pp"! ,� DRINKING FOUNTAIN FOODDISPOSER SPOSER �� I FLOOR/AREA DRAIN 1 INTERCEPTOR(INTERIOR) I I KITCHEN SINK LAVATORY ROOF DRAIN 1 I I SHOWER STALL SERVICE/MOP SINK TOILET ' 1 URINAL , WASHING MACHINE CONNECTION 1 I WATER HEATER ALL TYPES 1 WATER PIPING I I OTHER 1 ; I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ( 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ' LIABILITY INSURANCE POLICY Q 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 tr a nd ur a bestar my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co nc 'th ert nt provis n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SIGNATURE MP❑ JP CORPORATION❑# 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 1508-760-2681 —I CELL EMAIL \0(5 () m ShCV-eVI .Ct-1m CCX l k - C • C UO-\ J ter\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4i— •;7 t ' r CITY S. Yarmouth MA DATE 5/17/19 PERMIT # &O,/7--(20 4'7416 JOBSITE ADDRESS 36 Shoreside Dr. OWNER'S NAME Joseph Pandolfo IIT OWNER ADDRESS 3 Meadowcroft Rd., Burlington, MA 01803 TE 617-908-1227 FAX 9 TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL RESIDENTIAL 7 PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: 1 PLANS SUBMITTED: YES fl NOQ APPLIANCES Z FLOORS 1 2 3 1111 5 6 7 8 9 10 11 12 13 14 BOILER 111111 INIIIMEN MOM� BOOSTER MIEIMIM IIMMINIIIIIII 111111M_ CONVERSION BURNER 11111111111111111111111111 IMINIMIIMI IEEE Mlles COOK STOVE �! �� MI�� -11 M �1� DIRECT VENT HEATER ��1 1 _J it �� I�I� �l�I DRYER I I IIIIEII=II'lliIIIIIf�lIIIIIIIINMl l IMIMI FIREPLACE []L � FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER 1111111 MEM LABORATORY COCKS 1111111111111111111111111111•1111111111.111111111111111111 MI MAKEUP AIR UNIT IIIIIIIIIIIIIIIIIIIIIIIIIIIMBIIIIIIIIMIIIIIIIIIIFIIIIII 1.11-111111.1 OVEN I II IIIIII II 1 II'I11•111111 111111(1111111 I POOL HEATER MEW Ma 1.101 MILEMI1� ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER poll ppppoggill UNVENTED ROOM HEATER MT—TOMMTAIMM1 FM 01 11.1�IN WATER HEATER - ��F T�MI�� M_�! OTHER I IIIIIIIIIII1In-, -ir II. ��mr-witimmir l , MI milial'AgEssimmin ..] li ----1 �" 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 / 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 apd accurate to he b efmy knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli e wi I P ine 2ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME Keith J. Farnham 1 LICENSE # 11601 I SIGNATURE '-'—''..— MP i MGF JP JGF I7 LPG! CORPORATION Q# 3698C PARTNERSHIP 0# LLC S# COMPANY NAME: south Shore Heating & Cooling, ADDRESS 57 White's Path CITY South Yarmouth — , STATE MA1ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL 1EMAILI