HomeMy WebLinkAboutBLDP&G-18-001659 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
‘.�litla 3 CITY'West Yarmouth4.
MA DATE 08125I2017 PERMIT# �� '�'�7
JOBSITE ADDRESS L121 Camp Street#127 OWNER'S NAME. George Lewis i
OWNER ADDRESS ' 121 Camp Street#127 TEL 5087769589 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL S EDUCATIONAL RESIDENTIAL V'
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES` NO
FIXTURES 7 FLOOR-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
s....Yam..v.:. -__..._..—a..,.. r- ^�..... ,.^—v_-._...,. y - ......,'9� �.. ... .,.. ... ....."_.
BATHTUB ., 1 ,,
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM : 'u_
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
" ._.r.° .•.. ._. v =i.... ..
DEDICATED GRAY WATER SYSTEM ,�,._ ---W' t ` � r___
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN _.. _..
INTERCEPTOR(INTERIOR) a'KITCHEN SINK - - J � .___. . . ..._. -_
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL ° . 3
�.,1. _ ,,-
.::
4
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES L 1
WATER PIPING
OTHER _. 0 ~sr ;I --sr ._
! 5
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 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 a the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compl4afi Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. '"
PLUMBER'S NAME Phillip Durfee LICENSE# 13774 SIGNATURE -
MP i JP ril CORPORATION #1 PARTNERSHIP( #' 1LLC!j#L3152 ,; -s
COMPANY NAME Durfee Plumbing&Heating LLC j ADDRESS 12 American Way Unit 1
CITY'.South Dennis !STATE I1MAI ZIP �02660 TEL 508-619-3078 1
FAX 508-258-0592 CELL 508-801-8004 'EMAIL i p @durfee lumbin com sales durfeeIumbin .com
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
atE'-dui i=; CITY West Yarmouth MA DATE 08/25/2017 PERMIT# /''f /?'T c /�
JOBSITE ADDRESS 121 Campt Street#127 OWNER'S NAME George Lewis
OWNER ADDRESS 121 Campt Street#127 TEL 5087769589 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES Z 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.
CHECK ONE ONLY: OWNER AGENT
SIGNATURE OF OWNER OR AGENT 1
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac e best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complianc t ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Phillip Durfee LICENSE# 13774 SIGNATURE
MP MGF JP JGF LPG' CORPORATION # PARTNERSHIP __# LLC # 3152
COMPANY NAME: Durfee Plumbing&Heating LLC ADDRESS 2A Huntington Ave.
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-619-3078
FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;joy@durfeeplumbing.com