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Home My WebLink AboutBLDP&G-19-000728 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �� CITY W.Yarmouth 1 MA DATE 7/6/18 PERMIT#� � 72 JOBSITE ADDRESS 8 Quail Rd. J OWNER'S NAMEI David Mahoney 1 POWNER ADDRESS ' 50 Pleasant St., Braintree MA 02184 TEL 617-838-3535 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL RESIDENTIAL ,,; PRINT CLEARLY NEW: ri RENOVATION: `, REPLACEMENT:Li PLANS SUBMITTED: YES® NO FIXTURES Z FLOOR—. 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 SYSTEMEll DEDICATED GREASE SYSTEM j DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I DRINKING FOUNTAIN Mil ••D DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ill KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ®III ■MIIII ®■� WATER PIPING OTHER ®■■■MIMI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ' i NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW , LIABILITY INSURANCE POLICY•; '1 OTHER TYPE OF INDEMNITY L j 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 Ir,,, I 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 c ate est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pliance it rtinent ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME Keith J. Farnham LICENSE# 11601 IGNATUR -"""- MP i JP Ili CORPORATION i # 3698C (PARTNERSHIP 1#[ 1 LLC # COMPANY NAME South Shore Heating&Cooling Inc. I ADDRESS 57 Whites Path CITY LS2uth Yarmouth STATE [,,,,,_MAA ZIP 02664 TEL( 508-398-6901 FAX 508-760-2681 CELL l EMAIL F+ 1 1 - - --- - - - -_ -- i �1 I i 'J 1 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,��f� 5,"'t1=- CITY W.Yarmouth MA DATE 7/6/18 PERMIT#/ �//`ewe 7 z JOBSITE ADDRESS 8 Quail Rd. n OWNER'S NAME David Mahoney -11 GOWNER ADDRESS 50 Pleasant St., Braintree, MA 02184 TEL 617-838-3,535 JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ,.r.: RESIDENTIAL PRINT CLEARLY NEW:Lj RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NOij APPLIANCES Z FLOORS—. BSM 1 2 3 I 4 5 I 6 7 8 9 10 11 1 12 13 14 BOILER BOOSTER • CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER __ LABORATORY COCKS j MAKEUP AIR UNIT 7 OVEN POOL HEATER I _. _. ROOM/SPACE HEATER _ d ' „�. _ ROOF TOP UNIT j i TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER iiiii OTHER ll 1 I l_ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES i 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 ,_. 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;9te o the y nowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli with II in nt provisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. GL itf.444 PLUMBER-GASFITTER NAME Keith J. Farnham I LICENSE# 11601 SIGNATURE 1. MP _ MGF D JP JGF LPGI CORPORATION 0#L698C PARTNERSHIP LJ# I LLC Li# COMPANY NAME: South Shore Heating&Cooling, Inc ADDRESS 57 White's Path 1 CITY South Yarmouth STATE; MA .ZIP 02664 TEL 508-398-6901 ! I .,,„ i FAX 508-760-2681 CELL IIEMAIL a/. r .�