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HomeMy WebLinkAboutBLDP&G-20-004150 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK HMO . 111 '' �,.�aJ,� ,,J CITY SOUTH YARMOUTH MA DATE� �1/22/2020 PERMIT# y �—� • ,,. 4f` JOBSITE ADDRESS i30 COVE VIEW DR. OWNER'S NAMEITHERESE FREDETTE POWNER ADDRESS 30 COVE VIEW DR TELI(508)394-6909 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:Li REPLACEMENT:Li PLANS SUBMITTED: YES® NOD FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB [. '!.._—� .. II_ ] I! CROSS CONNECTION DEVICE i .; .___.J 1 ]I DEDICATED SPECIAL WASTE SYSTEM ,I_ _ I _ j� I Ij - -- 1I DEDICATED GAS/OIL/SAND SYSTEM 'I r t. 1 -1I 0 DEDICATED GREASE SYSTEM a I y ! 1ti 1 1 t E DEDICATED GRAY WATER SYSTEM 1 I II- DEDICATED WATER RECYCLE SYSTEM -f,_ - DISHWASHER I I II h I _ 1I DRINKING FOUNTAIN I I il Ii I� FOOD DISPOSER I II r -i; ' --11-- FLOOR/AREA DRAIN I r --ir INTERCEPTOR(INTERIOR) I I It I l I, KITCHEN SINK Q I m i_ �� I LAVATORY - I r— �( �_ROOF DRAIN r--ZrI II SHOWER STALL L SELL u n .._ :;_ l _ I .1 J SERVICE/MOP SINK �i.. _. TOILET i _.._.1._ II I II II I - - URINAL ..... . WASHING MACHINE CONNECTION I t' I U_ =I 1r� iI I j I l WATER HEATER ALL TYPES 1 - I 1 1-7-! WATER PIPING -' ®� OTHER ,H r I lJ _ . 11 I t all f 1' Its _ 1� tI policy INSURANCE COVERAGE: I have a current liabilityinsurance or its substantial equivalent which meets the requirements of MGL Ch.142. YES'j NO I1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY T1 BOND L_.1 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 [Ti 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 wwii h all P rti end on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. was/sJe' (....------ PLUMBER'S NAME I Keith J.Farnham �_ LICENSE# 11601 I SI A RE MPD JP© CORPORATION ID#I 3698C PARTNERSHIP[#I ILLCI1# COMPANY NAME LSouth Shore Heating&Cooling, I ADDRESS 57 Whites Path 1 CITY I South Yarmouth J STATE I MA I ZIP `02664 TEL 508-398-6901 1 FAX C08-760-2681 CELL I EMAIL (info@southshoreheatingcooling.com ___ d-a[t+ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •=.n Err / ` �'_ti y CITY ;SOUTH YARMOUTH MA DATE;01/22/2020 PERMIT#/--/ JOBSITE ADDRESS 30 COVE VIEW DR. OWNER'S NAME THERESE FREDETTE GOWNER ADDRESS 30 COVE VIEW DR TEL 508-394-6909 FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL ® RESIDENTIAL I PRINT CLEARLY NEW:IS RENOVATION: �1 REPLACEMENT:E PLANS SUBMITTED: YES Li NO APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1.111^ WM1 BOOSTER. XII CONVERSION BURNER a COOK STOVE DIRECT VENT HEATER DRYER T FIREPLACE '- FRYOLATOR 1 ,r FURNACE I®) 1--- ,, GRILLEII �� —i--- INFRARED HEATER LABORATORY COCKS .1111.1STAr--- �_MAKEUP AIR UNIT � ___ mm OVEN 1 i -_ rs- POOL HEATER (— ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER Mil■■■ ' WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES (v NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I vi OTHER TYPE INDEMNITY %_ 1 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 0 AGENT [J 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 a I Pertinent p of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Keith J.Farnham I LICENSE#L11601 1 t EcT-- MP I,'1 MGF j---1 JP El JGF❑ LPGI® CORPORATION #L3698C I PARTNERSHIP I #) I LLC®#I J COMPANY NAME:LSouth Shore Heating&Cooling, ADDRESS'57 White's Path L STATE rr MA ZIP 02664 ]TEL 1508-398-6901 CITY I South Yarmouth FAX 508-760-2681 CELL EMAILIinfo@southshoreheatingcooling.com `i-