HomeMy WebLinkAboutBLDP&G-18-002614 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY[ yarmouthport I MA DATE 16 1Xlia...._ 1 PERMIT# 7
JOBSITE ADDRESS 106 pheasant cove circle -1 OWNER'S NAME Peggy parent
POWNER ADDRESS i TEL 3620072 JFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL ❑ RESIDENTIAL L.1
PRINT CLEARLY NEW: I] RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES[i NO[_-r
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB __ -1'
CROSS CONNECTION DEVICE _.__a_.., " 1
DEDICATED SPECIAL WASTE SYSTEM M
DEDICATED GREASE SYSTEM _ {' tik---...DEDICATED GAS/OIL/SAND SYSTEM
I_.
DEDICATED GRAY WATER SYSTEM U I
DEDICATED WATER RECYCLE SYSTEM ]` 1! , 1
T _ -
- i
DISHWASHER — -- � Ir---- �i
/DRINKING FOUNTAIN C /-1
FOOD DISPOSER
FLOOR/AREA DRAIN I j,
INTERCEPTOR(INTERIOR) _ L.
KITCHEN SINK il- -
LAVATORY I ir ,, —..
ROOF DRAIN
SHOWER STALL -!I
SERVICE/MOP SINK IT - 1_ 1 ](
TOILET
URINAL (r—
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 2
WATER PIPING ( ,
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ram'] 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 L,1
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 ccura he best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co anc i II Perti t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME( Keith J. Farnham LICENSE# 11601 SIGNATURE
MPH JPLJ CORPORATION❑# 3698C 1PARTNERSHIPO# LLC❑#
COMPANY NAME Potith Shore Heating&Cooling, Inc. ADDRESS 57 Whites Path
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CITY
South Yarmouth I STATE MA j ZIP 02664 TEL 508 398-6901 I
FAX (-508-760-2681 CELL EMAIL
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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fit[ CITY 1 yarmouthport IMA DATE /r) t PERMIT# /,�/1I'-nt-e�'oefvq
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JOBSITE ADDRESS 106 pheasant cove circle j OWNER'S NAME peggy parent
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OWNER ADDRESS � 1 TEL 3620072 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL[_71 EDUCATIONAL 0 RESIDENTIAL LI
PRINT
CLEARLY NEW:[,µ j RENOVATION:1 ; REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
APPLIANCES-1 FLOORS-6 ! BSM 1 2 3 4 5 6 7 8 9 10 ' 11 12 13 14
BOILER . IL __I_ fi ' P_ r . .I ' ,_
BOOSTER
CONVERSION BURNER
COOK STOVE I
DIRECT VENT HEATER r/� r
i✓
DRYER L ,
I, _ i
FIREPLACE
FRYOLATOR + -t i
i } 1. —5 iigi) - ii____I
FURNACE I —1
GENERATOR
GRILLE . _+ I it-
INFRARED
HEATER I 1- _
LABORATORY COCKS 1 j '
MAKEUP AIR UNIT
OVEN _---.-__
POOL HEATER ,, j
ROOM/SPACE HEATER ---1 T .
ROOF TOP UNIT —'
TEST — _ _
UNIT HEATER ii. .
UNVENTED ROOM HEATER F. i_ . - i
WATER HEATER 2 = I
OTHER I --1!---
-1n .
11
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY Li 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 [11] AGENT L 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 an curat a best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli a it I Pertinent ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
—
PLUMBER-GASFITTER NAME keith J. Farnham - I LICENSE# 11601 SIGNATU
MP[Li MGF JP❑ JGF L. LPGI CORPORATION Q#13698C I PARTNERSHIP#1 _I LLC❑# I
COMPANY NAME: South Shore Heating&Cooling, Inc I ADDRESS r7 White's Path
CITY South Yarmouth 1 STATE MA ZIP 02664 TEL 508-398-6901 y I
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FAX 508-760-2681 CELL EMAIL