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Home My WebLink AboutBLDP&G-18-005664 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 7� �� CITY 1 South Yarmouth _ � MA DATE 04/04/18 PERMIT# W0-716' '`��47 JOBSITE ADDRESS 2 Hemlock Path OWNER'S NAME Rich Scales P _ ._ OWNER ADDRESS 2 Hemlock Path TEL 7813400244 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL RESIDENTIAL �-, PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:71 PLANS SUBMITTED: YES 7 NO'. j FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE L. DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM — DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM ` DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) — KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL :— SERVICE/MOP SINK _ _ TOILET URINAL • __. _. - • ._ - WASHING MACHINE CONNECTION — „__... WATER HEATER ALL TYPES 1 WATER PIPING _ ~ OTHER - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i 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 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 aCCIJ to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliant" all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / ` PLUMBER'S NAME`Phillip Durfee LICENSE# 13774 1 SIGNATURE MP v JP __.3CORPORATION' # PARTNERSHIP # LLC #I3152 COMPANY NAME Durfee Plumbing&Heating LLC ;ADDRESS, 12 American Way Unit 1 CITY South Dennis f STATE MA ZIP 02660 TEL 508-619-3078 al FAX 508-258-0592 CELL 508-801-8004 EMAIL phtl@durfeeplumbing.com;sales@durfeeplumbing.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK TAW- CITY South Yarmouth MA DATE 04/04/18 PERMIT# /94PP"/(-0°564g JOBSITE ADDRESS 2 Hemlock Path OWNER'S NAME Rich Scales GOWNER ADDRESS 2 Hemlock Path TEL 7813400244 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 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 / I hereby certify that all of the details and information I have submitted or entered regarding this application are true a yrt a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli II Pertinent 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 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