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HomeMy WebLinkAboutBLDP&G-16-004423 j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � ,0 CITY 3affrth Y/iflflØ1ffl MA DATE VIreje PERMIT#//-UP'i& -CC`.2 • j JOBSITE ADDRESS 2? f n f 17 Rica : NER' N . t'� rr P OWNER ADDRESS 7i TEL 3`(7- Y4i FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIALjcJ PRINT CLEARLY NEW:L RENOVATION:! I REPLACEMENT PLANS SUBMITTED: YES Ell FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 BATHTUB = IIII l_I ' CROSS CONNECTION DEVICE - _ DEDICATED SPECIAL WASTE SYSTEM I ; I DEDICATED GAS/OIUSAND SYSTEM j r— J; _ DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM I .L. . I DEDICATED WATER RECYCLE SYSTEM J i i__ 1 h F- DISHWASHER 1 I— -- DRINKING FOUNTAIN ! —1 - 1 FOOD DISPOSER �_ I l — FL OR/AREA DRAIN I Ill L I INTERCEPTOR O (INTERIOR) i_ e..,.Il !4 I F J !I KITCHEN SINK +-_ ' ,...___ ____ Q 11 LAVATORY I .�__ i I�I ( d I ROOF DRAIN 1- ;___. _. II r SHOWER STALL _.. ___ 1-- —1 SERVICE/MOP SINK ----�.. II �I.I Y — TOILET _.,r�, I � FF. - 1 URINAL 1111 -4, WASHING MACHINE CONNECTION I 11 lI 1l 0 WATER HEATER ALL TYPES _I = , . WATER PIPING IC ! I i OTHER 'Ems ,----11- __ . ME MI MIN ; 1 r ,-----11 I i INSURANCE COVERAGE: J I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ 1 NO !v IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY LJ 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• •WNER AGENT 1.13 SIGNATURE OF OWNER OR AGENT / _ I hereby certify that all of the details and information I have submitted or entered regarding this application are t ' .rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co• all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� PLUMBER'S NAME Phillip Durfee LICENSE# 13774 / SIGNATURE MP[ JP CORPORATION!^#- PARTNERSHIP! I# 1 LLC r'1#r3152— _1 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 t..r I- .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ii 4 CITY C2 igidlafrtil _ MA DATE' ( 1�� PERMIT# &Dh�& -CVe/SC K. J JOBSITE ADDRESS I COI-At/Pi K _{ ! ce c 1 OWNER'S NAME G OWNER ADDRESS TEL ..."4.,-_,..7 �J. Off_JFAX1 I TYPE OR OCCUPANCY TYPE COMMERCIAL~1 EDUCATIONAL 1 RESIDENTIAL ry' PRINT CLEARLY NEW: RENOVATION:[] REPLACEMENT: \ PLANS SUBMITTED: YES 1 NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ ` CONVERSION BURNER -1r-- :: -. _ COOK STOVE DIRECT VENT HEATER 11_ DRYER FIREPLACE - - FRYOLATOR7 �... _`. ) FURNACE GENERATOR GRILLE {� ., ,_, U _ I,. ' INFRARED HEATER I LABORATORY COCKS — ` MAKEUP AIR UNIT - ir__ OVEN — POOL HEATER ROOM I SPACE HEATER 1 -Li- 1 ROOF TOP UNIT i " j-- `. -1 _.I (� ._ r� TEST � 1 ...-] UNIT HEATER f � -i UNVENTED ROOM HEATER - [' I -1(� I WATER HEATER ' _ a_ _ . �. OTHER r I _ 1 tl _ i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO j I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND I 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 0 AGENT J 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 a o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Phillip Durfee LICENSE# 13774 SIGNATURE MP..L MGF r JP JGF LPGI CORPORATION # PARTNERSHIPf—f#r —1 LLC 0#[3152 COMPANY NAME: Durfee Plumbing&Heating LLC ADDRESS 12A Huntington Ave. _ CITY 1 South Yarmouth 1 STATE I MA ZIP 102664 TEL 508-619-3078 FAX 8-258-0592 CELL1 508-801-8004 EMAIL phil@durfeeplumbing.com;joya©durfeeplumbing.com fs;