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Home My WebLink AboutBLDP&G-17-004509 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �,— 1 MA DATE ` �n, PERMIT# ��`��s i� CITY' „` V�. ., (I) s cc/ ®nil®_ _,�:.�.r� - ____ OWNERS NAME Ce,4, ` ih► m JOBSITE ADDRESS .; _,_ POWNER ADDRESS �. . > TEL1 'FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL -1 EDUCATIONAL j RESIDENTIAL Litt PRINT CLEARLY NEW: 'LLI RENOVATION:I, REPLACEMENT: �"-- PLANS SUBMITTED: YES LI NO( y FIXTURES 1 FLOOR-0 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 It DEDICATED GRAY WATER SYSTEM !` DEDICATED WATER RECYCLE SYSTEM _,.. i_� DISHWASHER -- - DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ - j KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL I i , SERVICE/MOP SINK TOILET :;:,' • .ill.1' URINAL .4 WASHING MACHINE CONNECTION L _ • ` WATER HEATER ALL TYPES I - � WATER PIPING OTHER I —! 1 _ i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 17! NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY i.- 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 rili 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 c,c plia ce w•�i provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f 7—LICENSE#`11601 SIGNATURE PLUMBERS NAME[Keith J.Farnham MP /:' JPD CORPORATION 71#1;(;..qt Cr IPARTNERSHIPIX -_ .C_.._.-. COMPANY NAMELSouth Shore Heating&Cooling, Inc. ADDRESS I 57 Whites Path t � CITY1 South Yarmouth ZIP I.02664 STATE MA ; TEL L,508398 6901 EMAIL FAX `508 76060 2681 CELL _ _ s ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ado r \--\te,t+gr- ? 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK P"-i-_ cal 1� /�,' I = CITY MA DATE i 3 j /rPERMIT# / - ?6(93 1 JOBSITE ADDRESS��' ��+� �t1nS � OWNER'S NAME ��'�-(!ryl✓1,�( .r_--q�. GOWNER ADDRESS I 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL : RESIDENTIAL PRINT CLEARLY NEW:Lj RENOVATION: REPLACEMENT: t-' PLANS SUBMITTED: YES' -' NOLI APPLIANCES 1 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/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER ( ° E 4 WATER HEATER OTHER t , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES _' NO 11, I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY BOND i__ 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 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 comp iance ith Pet provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE# 11601 SIGNATURE MP MGF JP JGF LPGI CORPORATION ,(#I" ;,(` ( PARTNERSHIPLI# LLC L#�� COMPANY NAME: South Shore Heating&Cooling, Inc ADDRESS 57 White's Path CITY South Yarmouth i STATE MA ZIP 02664 TEL[08 398-6901 FAX 508-760-2681 CELL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES