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Home My WebLink AboutBLDP&G-18-007152 va MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK rc _�� CITY SOUTH YARMOUTH ` MA DATE 6/8/18 PERMIT#, /F'0 ' 7/ JOBSITE ADDRESS 19 CENTERBOARD LANE OWNER'S NAME JOHN QUINN POWNER ADDRESS 81 HOPE AVE WORCESTER,MA 01603 _ TEL 508-414-6307 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Q RESIDENTIAL Q PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:Eli PLANS SUBMITTED: YES Li N01 FIXTURES 7 FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB i I DEDICATED GRAY WATER SYSTEM ' I. s S DEDICATED WATER RECYCLE SYSTEM I [ FOOD DISPOSER , W MiMri 1 KITCHEN SINK 'jj511.M. •• i 4. „,.. .. ROOF DRAW I ( �' ! I I SHOWER STALL I 1 I I j SERVICE I MOP SINK ® .a v I TOILET I — URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ` 1 3 .. WATER PIPING ,e . _a , OTHER E i € iII I s INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ' NO I 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Q BOND Q 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. C ES' ONE NLY: 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 applic.ti.lit re rue :n accurat est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co plia with al ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. W PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 SI A MP EJ JP 0 CORPORATION # 3969 PARTNERS • # LLCI _ i# COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com I/ klaube@callmurphys.com ai-f 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY SOUTH YARMOUTH MA DATE 6/8/18 PERMIT#,l DP/t ' 7/5 JOBSITE ADDRESS 19 CENTERBOARD LANE OWNER'S NAME JOHN QUINN OWNER ADDRESS 81 HOPE AVE WORCESTER, MA 01603 TEL 508-414-6307 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO 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 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 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. CHE K 0 E 0 LY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati in are tru: a d ccu e to the bes my knowledge and that all plumbing work and installations performed under the permit issued for this application will b: in ompl:no; •th all ent provisi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15851 I NATURE MP MGF JP JGF LPGI CORPORATION # 3969 PARTNERSHIP # LLC # COMPANY NAME: Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com // klaube@callmurphys.com 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