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HomeMy WebLinkAboutBLDP&G-23-005499 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK kJOBS, g� CITY YARMOUTH MA DATE 4/4/23 PERMIT# BLDP-23 005499 �s - z ITE ADDRESS 32 PEREGRINE LN OWNERS NAME CLARENCE E WHITNEY TRUST P OWNER ADDRESS C/0 ANNE WHITNEY 345 REEDS LANDING SPRINGFIELD,MA 01109 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO FIXTURES I 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 0 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. PLUMBERS NAME keith farnham LICENSE#1601 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME south shore heating&cooling ADDRESS 57 whites path CITY south yarmouth STATE MA ZIP 026640000 TEL 5083986901 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT S PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK er r CITY YARMOUTH MA DATE April 04,2023 PERMIT# BLDP-23-005499 "` JOBSITE ADDRESS 32 PEREGRINE LN OWNER'S NAME CLARENCE E WHITNEY TRUST G OWNER ADDRESS C/O ANNE WHITNEY 345 REEDS LANDING SPRINGFIELD MA 01109 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO El 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 1 SPACE HEATER ROOF TOP UNIT , • TEST UNIT HEATER . UNVENTED ROOM HEATER WATER HEATER 1 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER 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. 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 El MGF El JP El JGF❑ LPG' El CORPORATION El# PARTNERSHIP El# LLC El# COMPANY NAME: south shore heating&cooling ADDRESS. 57 whites path, CITY south varmouth STATE MA ZIP 026640000 TEL 5083986901 FAX CELL EMAIL S31ON MJIA321 NV1d #iIWb3d $ :333 11Wa3d 3Hl SV S3/183S NOI1V3 lddV SIHI oN sa). S31ON NOI103dSNI 1VNId AlNO 3Sf1210103dSNI dOd 3OVd SIHI S3LON NOI103dSNI SVO H0110d