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HomeMy WebLinkAboutBLDP&G-18-006565 . ^ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK m vis �/ �v � CITY Yarmouth MA DATE[/17/18 PERMIT#/;r�)j'�Y"�6,�(L�i JOBSITE ADDRESS 93 Constance Ave I OWNER'S NAME Sheri Lynne POWNER ADDRESS Same I TELF5082370491 FAX 7 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL _, RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ' PLANS SUBMITTED: YES NOD FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB --fr--- rr __ r___. CROSS CONNECTION DEVICE k DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM 1 11, j 1 DEDICATED GREASE SYSTEM [ P DEDICATED GRAY WATER SYSTEM r-- DEDICATED WATER RECYCLE SYSTEM DISHWASHER J__ DRINKING FOUNTAIN j . FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK __.,i LAVATORY ROOF DRAIN 1 I SHOWER STALL - . SERVICE/MOP SINK TOILET - 4 l URINAL _ WASHING MACHINE CONNECTION f WATER HEATER ALL TYPES i 1 __r_ 1 -- .- WATER PIPING _-, .__- OTHER 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 v OTHER TYPE OF 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 Li 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 accurate 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 with all Pertine • "on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. —� I PLUMBER'S NAME Richard Farrenkopf I LICENSE# 33051 J SIGNATURE MID:.. JPD CORPORATION(]#1 iPARTNERSHIP®# LLC. J#, COMPANY NAME R Farrenkopf III P+H 1 ADDRESS 20 Haywood Ave CITY South Yarmouth STATE Ma ZIP 102664 TEL 5083603175 FAX CELL I EMAIL nL ichardfarrenkopf@yahoo.com J Weft MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -,C=Y= ti fgi CITY Yarmouth MA DATE 5/17/18 PERMIT#IOP/F"1(S/o'5 a JOBSITE ADDRESS 93 Constance Ave OWNER'S NAME Sheri Lynne GOWNER ADDRESS Same TEL 5082370491 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES NO APPLIANCES 7 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 f OVEN I i- POOL HEATER ' •,.....k: ROOM/SPACE HEATER ROOF TOP UNIT ' TEST < 0-1) 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 1 ' 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 and accurate 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard Farrenkopf LICENSE# 33051 SIGNATURE MP MGF JP JGF LPGI CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: R Farrenkopf III P+H ADDRESS 20 Haywood Ave CITY South Yarmouth STATE Ma ZIP 02664 TEL 5083603175 FAX CELL EMAIL richardfarrenkopf@yahoo.com j