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Home My WebLink AboutBLDP-21-001727 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK iw4 CITY YARMOUTH MA DATE 10/5/20 PERMIT# BLDP-21-001727 71, JOBSITE ADDRESS 28 PLEASANT ST OWNER'S NAME THOMAS J ROCHE REALTY INC OWNER ADDRESS 28A PLEASANT ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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❑ 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 at plumbing work and Installations performed under the permit Issued for this application wit be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME [Keith Farnham LICENSE 16601 SIGNATURE MP ❑ JP ❑ CORPORATION OH PARTNERSHIP ❑# LLC ❑# COMPANY NAME SOUTH SHORE HEATING 8 ADDRESS 57 White's Path COOT ING CITY South Yarmouth STATE IMA I ZIP 02664 TEL FAX CELL EMAIL info@soulhshoreheatingcooling.com 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY yarmouth MA DATE (9/16/2020 PERMIT # JOBSITE ADDRESS 28 pleasant st OWNER'S NAMErThomas roche OWNER ADDRESS „. ..1] 5082477913FAX - TYPE OR OCCUPANCY TYPE COMMERCIAL ni EDUCATIONAL RESIDENTIALL PRINT CLEARLY NEW: ,Li RENOVATION: , REPLACEMENT: . PLANS SUBMITTED: YES fJ NO0 FIXTURES Z FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 I 11 12 13 14 BATHTUB 11010141110011111101111111 I11001110110i_.. i CROSS CONNECTION DEVICE x ION NMI 1101011111011111I111111111111101111MOM DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM . . . ._ : .. ..:._. .•-- 111.11.0111.1101111M1111111111110001111111111 --- - DEDICATED GREASE SYSTEM DEDICATED . • IIIMOIMININIMMINIMINOM DEDICATED WATER RECYCLE SYSTEM I_r iiimplornanumu DISHWASHER --_ ,1� 0� 10�. DRINKING FOUNTAINIMIIIBEF=111.111111111.11111110.11.1MMIIIIIIIIIM. AIM I�I�E� �[�� ..- • - • .- • ►�1 11�1 T ��I Igimurriow��I Illl r Ii 1 l 1mm limmiumornmonempumaii Tom_ I� �I I ��T LAVATORY -._.. '---� 1101111111111___ 1�0.�� ROOF DRAIN - . -. SHOWER STALL 11 11111101111l .0111111111_1 WATER HEATER ALL TYPES x J1=111111 _ WATER PIPING _ — 1 "17 '71 101111010011111M OTHER _ _ _ 11111M11_11111.1M111.1.1110.1110111101.11111M11111 —"rttlf :s tYl 9 WW`tr t""' fi' "..v11 37t E Y C171tT7 - .ltt i ":" "(� - t=2' - vent • i ....u.........—.......... .,..d.«......,....«,,,...�...ww,,...,..w,,,-,,,. ,,..w,.. .... ..; ,.Nc �.nr• f .,.,....., .�.,..- L..,,�.,..... _t,..-..--. .,...W,..+.�. .................a.. .....�1 ' �.....�L— INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO EJ IF YOU CHECKED YES. PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND El 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 Lw ' SIGNATURE OF OWNER OR AGENT I I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to to the be of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with II ent pro ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J. Farnham .._.. .. .., , LICENSE # 11601 � IGNATURE .W. ... MP � JP CORPORATION _ � # 3698C PARTNERSHIP_„I#L, LLCD# COMPANY NAME South Shore Heating & Coolln9 ADDRESS L57 Whites Path CITY South Yarmouth -. STATE MAJ ZIP [ 02664 TEL r508-398- ~�" FAX 508-760-2681 CELL EMAIL info a southshoreheatirQcoolin .com—" ._ ---�--- 00A-Ki V� Inspections Salesman will Permit #: Name Thomas roche Address 28 pleasant st Town South yarmouth Telephone # 2477913 Tennant, Caretaker Thomas roche Telephone # List of Appliances Gas boiler and indirect water heater Work Done By cp Completion Date Voice Mail Date Rough Inspection Date Final Inspection Date Notes: