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HomeMy WebLinkAboutBLDP&G-20-004170 ' A , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =1°� i+ CITY Yarmouth Port I MA DATE 1/29/2020 PERMIT#04WW"0U y/�( JOBSITE ADDRESS 5 Kate's Path OWNER'S NAME Joan Madden POWNER ADDRESS SAME I TEL 508-362-9024 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: I I RENOVATION:E REPLACEMENT:Q PLANS SUBMITTED: YES El NOQ FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I -_-,r_______ �„---._-1F ,---1' ---- CROSS CONNECTION DEVICE [ ____ n- '�� DEDICATED SPECIAL WASTE SYSTEM r r '77 --1T DEDICATED GAS/OIL/SAND SYSTEM —1' H DEDICATED GREASE SYSTEM L - , DEDICATED GRAY WATER SYSTEM r (-�--- DEDICATED WATER RECYCLE SYSTEM u DISHWASHER r - -1�j —I! 7-1— DRINKING FOUNTAIN` ' -E-- r---� 1 FOOD DISPOSER 1---:— i J i, 7 FLOOR/AREA DRAIN a r— 7 INTERCEPTOR(INTERIOR) L_ KITCHEN SINK LAVATORY r 1 ii ROOF DRAIN 0 jJ 111 SHOWER STALL I— 1 ^h -1I SERVICE/MOP SINK -�. TOILET ■ �L_J—_ ._I URINAL WASHING MACHINE CONNECTION l �I 1 1 1�` —! WATER HEATER ALL TYPESI M. � IF WATER PIPING U 1P i i --1--11--11--1,- , 1 OTHER �M!illifflarliilill! ,111111i v II :1- -] —ll— 1 r I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of rylt Ent NE 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW (/ LIABILITY � � i �/��' oINSURANCE POLICY ' OTHER TYPE OF INDEMNITY BOND El AN G 2Q2 3 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage requiretby��t 9Q� j d�_� Lf3(NG�c{�A1NT t Massachusetts General Laws,and that my signature on this permit application waives this requirement. •• sy ___,-. CHECK ONE ONLY: OWNER El AGENT El 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 accur to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with II • pro ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 • ', IGNATURE MPH JP El CORPORATIONQ# 3698C PARTNERSHIP®# LLC # COMPANY NAME I South Shore Heating&Cooling ADDRESS 57 Whites Path CITY South Yarmouth I STATE MA ZIP 02664 TEL 508-398-6901 J FAX 1508-760-2681 CELL EMAIL info@southshoreheatingcooling.com l C—_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �o� n4 CITY Yarmouth Port 1 MA DATE 1/29/2020 PERMIT# r 9P ' 'O 9/7() JOBSITE ADDRESS 5 Kate's Path OWNER'S NAME Joan Madden OWNER ADDRESS SAME TEL FAX PRI OR OCCUPANCY TYPE COMMERCIALfl `r EDUCATIONAL J RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT:Eli PLANS SUBMITTED: YESJ NOD 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 t F. MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST r I UNIT HEATER L UNVENTED ROOM HEATER WATER HEATER t OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142----Y 'NO . I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW .4 go-3 VU 011 9 2Q2b LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY tND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage require t LeT I ED TM NT Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ' AGENT D 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 ac urate 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 all e i n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Farnham LICENSE# 11601 j NATURE • MP MGF JP JGF LPGI CORPORATION Q#r698C PARTNERSHIP # i LLC[1]#L COMPANY NAME: South Shore Heating&Cooling, ADDRESS 57 White's Path CITY South Yarmouth STATE I MA j ZIP 02664 TEL 508-398-6901 FAXC508-760-2681 CELL EMAIL info@southshoreheatingcooling.com (R4-