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HomeMy WebLinkAboutBLDP&G-19-000828 F MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK tt' j uth CITY[Yarmo Port 1 MA DATE 08/01/2018 j PERMIT#,,AD/ /7 JOBSITE ADDRESS 6 Clinton Drive —_ OWNER'S NAME!Evelyn Hayes POWNER ADDRESS 6 Clinton Drive TEL 5083621785 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 1 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES j i NO FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _. _DEDICATED GAS/OIUSAND SYSTEM .� _DEDICATED GREASE SYSTEM �� DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER . _. .: if j DRINKING FOUNTAIN FOOD DISPOSERv FLOOR/AREA DRAIN , INTERCEPTOR(INTERIOR) I i KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING L OTHER L___ t J 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 0 BOND 0 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 r*eir t e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' /roll I ertinent 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 11 CORPORATION # PARTNERSHIP # LLCM j# 3152 ' COMPANY NAME Durfee Plumbing&Heating LLC ADDRESS 12 American Way Unit 1 CITY South Dennis STATE MA ZIP 02660 TEL 508-619-3078 FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;sales@durfeeplumbing.com G--gIf { A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i Msr CITY Yarmouth Port MA DATE 08/01/2018 PERMIT# ��lZ� JOBSITE ADDRESS 6 Clinton Drive OWNER'S NAME Evelyn Hayes OWNER ADDRESS 6 Clinton Drive TEL 5083621785 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL � PRINT 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 - i WATER HEATER 1 I 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: OW 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 r he best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia 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 LPGI CORPORATION # PARTNERSHIP # LLC # 3152 COMPANY NAME: Durfee Plumbing&Heating LLC ADDRESS 12 American Way#1 CITY South Dennis STATE MA ZIP 02660 TEL 508-619-3078 FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;sales@durfeeplumbing.com 4r- 74/