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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
'-2.41� CITY jyarmouth I MA DATE 111/22/19 I PERMIT# /WP-020(Ya',9i7&
JOBSITE ADDRESS 1.193 Camp St. Unit H3 _j OWNER'S NAME Davenport Realty
POWNER ADDRESS f 19'3 Camp St. Unit H3 TEL 508-367-0116 1FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 1_ j EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW:r- RENOVATION:E REPLACEMENT:0 PLANS SUBMITTED: YES® NOE]
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB " ___I.' I' i `!
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM i �
`mil A 1
DEDICATED GAS/OIL/SAND SYSTEM r j
DEDICATED GREASE SYSTEM C. tl ti_. { `�'
DEDICATED GRAY WATER SYSTEM r soti_
DEDICATED WATER RECYCLE SYSTEM L it I 'l
DISHWASHER ,- r I 1
DRINKING FOUNTAIN I m 1 _-.ai
FOOD DISPOSER L
FLOOR/AREA DRAIN . r
INTERCEPTOR(INTERIOR) ��'
KITCHEN SINK '
LAVATORY
ROOF DRAIN I-_.
�{ I;
SHOWER STALLii
SERVICE/MOP SINK � __-1- I 1
TOILET .1r
URINAL 11
WASHING MACHINE CONNECTION [ i
WATER HEATER ALL TYPES r —1
WATER PIPING I1
l � - ..OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES° NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY LI 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 El 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 an ccur to 0 o my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliay> with II rti t pr ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' I
PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 SIGNATURE
MPH JP-1 CORPORATION 0# 3698C PARTNERSHIPLI# LLCTI#
COMPANY NAME South Shore Heating&Cooling j ADDRESS 157 Whites Path
CITY South Yarmouth STATE I. MA I ZIP 02664 TEL 51)8-398-6901
FAX 508-760-2681 ,CELL I EMAIL info@southshoreheatingcooling.com
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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U CITY lyarmouth MA DATE'11/22/2019 i PERMIT# P/-��0(9—CV GI7 '
JOBSITE ADDRESS 193 Camp St. Unit H3 OWNER'S NAME Davenport Realty
GOWNER ADDRESS 193 Camp St. Unit H3 TEL 508-367-0116 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL
PRINT
CLEARLY NEW: _ RENOVATION: __ REPLACEMENT:0 PLANS SUBMITTED: YES`L.1 NO a
APPLIANCES 1. FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER -
e_z �
BOOSTER
CONVERSION BURNER
COOK STOVE I
DIRECT VENT HEATER 1 ! 1
DRYER
FIREPLACE ,111: '
FRYOLATOR
FURNACE
GENERATOR _ I �I� : _..
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER I 1 I
ROOF TOP UNIT g --I[
TEST
UNIT HEATER I^
UNVENTED ROOM HEATER
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 NO
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 ,A
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 an accur to o th of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia I with IInt pro sion 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 0# 3698C PARTNERSHIP tb LLC 0#MIIIIIII
COMPANY NAME: South Shore Heating&Cooling, i ADDRESS 57 Whites Path
CITY L South Yarmouth STATE MA ZIP 02664 TEL 508 398-6901
FAX 508 760 2681 CELL EMAILIInfo@southshoreheatingcooling.com
GR l.)-