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HomeMy WebLinkAboutBLDP&G-19-006748 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK C.7,.. ' T;p CITY west yarmouth MA DATE 5/20/2019 PERMIT# . .---,9 JOBSITE ADDRESS 379 winslow gray rd OWNER'S NAME Joshua devin POWNER ADDRESS TEL 3607714 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I U L U U U U U D U U U U I CROSS CONNECTION DEVICE I U 11 II U l U II U U U U U DEDICATED SPECIAL WASTE SYSTEM I [ I. U l U U U I 1 L U U DEDICATED GAS/OIL/SAND SYSTEM I 1 L II IL I U l II II L U U DEDICATED GREASE SYSTEM J [ [ [ [ L U U l 1 U U U U DEDICATED GRAY WATER SYSTEM L l U 1 L L 1 U DEDICATED WATER RECYCLE SYSTEM I U 1 I [ I II U B 1 U U DISHWASHER I U I U I U 0 U U Im' U DRINKING FOUNTAIN FOOD DISPOSER U [� U 1U [ I. 1 U L U U FLOOR/AREA DRAIN I [ I U U U [ U U I U L [ INTERCEPTOR(INTERIOR) J I iI U I 1 11 I I B L 1 U i KITCHEN SINK I U II II U LI U U U U (I U U LAVATORY L_ l I [ L I. l I< 1 ROOF DRAIN L I I I IL I L L ii lU !, SHOWER STALL I _ LI I I ----7-17- SERVICE/MOP SINK I — { — t. 1F TOILET ^_-11-1-1.I- 1, _ I _] URINAL _I—F-1. _-1.---1. _ —Ill WASHING MACHINE CONNECTION WATER HEATER ALL TYPES x [ _ I [ U U I U i WATER PIPING OTHER J _U i I 1 U U I U I U U J U J ll U I U U U U U U U INSURANCE COYERA1e E: V V V I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E. NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 7 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 and .( u to Of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c ianc`'th a inent p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Famham LICENSE# 11601 SIGNATUR MP El JP❑ CORPORATION El# 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 cly C> v SCA_A-h5h 0rchan--)1'-9 Cc-) i nci . G G n-,I 1,k1 `f r-" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ ''Tiff CITY west yarmouth MA DATE 5/20/2019 PERMIT#/3440-79---ad JOBSITE ADDRESS 379 Winslow gray rd OWNER'S NAME Joshua devin GOWNER ADDRESS TEL 3607714 FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL U EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:Li RENOVATION:❑ REPLACEMENT: ! PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I �� I'��I BOOSTER _ ����� r 1 I CONVERSION BURNER I [ COOK STOVE I DIRECT VENT HEATER DRYER FIREPLACE r— IC 10— IIIIIMI 111.111 !Or; I FRFURNACEYOLATOR OR r— r - -7 1 ,-- r--111, ; , 1 i GENERATOR '1 I GRILLE r • �I -moms INFRARED HEATER _ ®- LABORATORY COCKS 1 MB 1 I} MAKEUP AIR UNIT — 1- MI r •_ MI OVEN ICI POOL HEATER Mill11 111•11=I ROOM/SPACE HEATER IIMMIMMW-IL. L ----7 , MI-- IM-M--, M ROOF TOP UNIT IMMEMIMMIIIMMIMMIN TEST � IIIINIMIIIIMIM 11.01.111 _ UNIT HEATER I.11111III♦IIII lin M IIM UNVENTED !-O• ��� ]ME WATER HEATER X - --! WIMP ., , r� •_ .I I OTHER I MI IT I_I ____, _ ,, , ,1 I III ril INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO Li I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I v-I OTHER TYPE INDEMNITY I I BOND Li 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 I I 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 ac rat to y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp. e wi a P rt�provis of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Famham LICENSE# 11601 SIGNATURE MP El MGF I JP© JGF❑ LPGI❑ CORPORATION Q# 3698C PARTNERSHIP #I _J LLC❑# COMPANY NAME: South Shore Heating&Cooling, ADDRESS 57 White's Path CITY !South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901 FAX[08-760-2681 j CELL EMAIL