HomeMy WebLinkAboutBLDP&G-19-002819 SO#134982 $80 COMBO
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
""e— CITY YARMOUTH MA DATE 10/31/18 PERMIT#,,f^DP/?'{VAFire
JOBSITE ADDRESS 103 WHITE CEDAR RD OWNER'S NAME PETER TOBEASON
POWNER ADDRESS SAME �.,u TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EJ EDUCATIONAL RESIDENTIAL 0
PRINT _
CLEARLY NEW:El RENOVATION:il REPLACEMENT: PLANS SUBMITTED: YES NO
FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB i _ I
CROSS CONNECTION DEVICE �... [
DEDICATED SPECIAL WASTE SYSTEM .1
DEDICATED GAS/OIL/SAND SYSTEM [ ,, s,l ... , .„ f i ,
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM I
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAINFOOD DISPOSER ,
t .....] i. i i ? 3 - 1 ,
FLOOR/AREA DRAIN ,
INTERCEPTOR(INTERIOR)
KITCHEN SINK . 1
LAVATORY
1
it
ROOF DRAINSHOWER STALL , .,
,
SERVICE/MOP SINK
i,. 11 11.1. il',,
IIIIIIIIIIII
TOILET
_
URINAL 1 �r 1
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1 !
WATER PIPING i ., V
OTHER I i
I . 1
I .
q i 1 I
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 i OTHER TYPE OF INDEMNITY D BOND El
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.
ECKSONE 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 appli .�• :re t e a • - • - - o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application •- corn, .•nce with all Pe -nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 411
PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 ‘‘IT
IGNA I'E
MP[ JP[, CORPORATION #[3969 PARTNERSHIP[:]# LLC,J#
COMPANY NAME Murphy Services Inc , ADDRESS 34 Whites Path
CITY South Yarmouth I STATE[ MA I ZIP 02664 J TEL 508-760-1660
FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com // klaube@callmurphys.com
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
• SO#134982 $80 COMBO
�' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE 10/31/18_ PERMIT#/ PP W''004 27
JOBSITE ADDRESS 103 WHITE CEDAR RD ;OWNER'S NAME PETER TOBEASON
GOWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL 7,1
PRINT _...
CLEARLY NEW: RENOVATION: „ REPLACEMENT: i,ry PLANS SUBMITTED: YES NO_,,,
APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11. 12 13 14
BOILER
ti
BOOSTER , : ,.
I_.
CONVERSION BURNER I s . F P
COOK STOVE y
DIRECT VENT HEATER
✓ I
DRYER
FIREPLACE .'
FRYOLATOR
FURNACE i ,
GENERATOR
GRILLE
INFRARED HEATER
I E 1 °;
LABORATORY COCKS _ 7.... ,.n . .-.�.t . _.
MAKEUP AIR UNIT
OVEN I r
POOL HEATER : s
ROOM/SPACE HEATER
ROOF TOP UNIT : ..m,,
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER.. .. I. 1
OTHERi .
L
i_ .- .
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ri '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 r__ AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application . - ,e and .ccur. o the •: t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be ii •ianc- ' all Pertinent pre i '•n of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
,„„ ...„„.._ •. ,..._... ...„ • A Ai . ..:.„,4
PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 ( .,. NA RE
MP .a' MGF JP JGF LPGI iljCORPORATION #3969 i PARTNERSHIP`�# LLC #
COMPANY NAME: Murphy Services Inc j ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA 'ZIP 02664 TEL!508-760-1660
FAX,508 760-1670 CELL, EMAIL cshea@callmurphys corn // klaube@callmurphys.com
(�` 7
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