HomeMy WebLinkAboutBLDP&G-19-00763 ^ ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Q3-':;�� " CITY Yarmouth I?et1 j MA DATE:07/31/2018 PERMIT#/ - ', /�` y
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JOBSITE ADDRESS 10 New Holland Road —1 OWNER'S NAME] hris Keegan
POWNER ADDRESS L10 New Holland Road _ I TEL.,5082216636 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL —1 RESIDENTIAL L1
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES I NOr,,/
FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB ------1,-
----
CROSS CONNECTION DEVICE
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 j
FLOOR/AREA DRAIN -- "
INTERCEPTOR(INTERIOR)
KITCHEN SINK
9
LAVATORY F . .
ROOF DRAIN _.
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL _'-- -----1 _ _ -.
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1
WATER PIPING p._..
OTHER .1-- (r.
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 Li 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: OWNE AGENT Q
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 complian rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Phillip Durfee LICENSE# 13774 1 SIGNATURE
MP i JP CORPORATION #; PARTNERSHIP # 1 LLCL# 3152
COMPANY NAME Durfee Plumbing&Heating LLC ADDRESS 112 American Way Unit 1
CITY South Dennis STATE' MA ZIP 02660 TEL 508-619-3078 I
FAX 508-258-0592 CELL T508-801-8004 EMAIL philOdurfeeplumbing.com;sales@durfeeplumbing.com �� M�
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• • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
•'AWN" CITY Yarmouth Port MA DATE 07/31/2018 PERMIT#ha'P-1 ocv k
JOBSITE ADDRESS 10 New Holland Road OWNER'S NAME Chris Keegan
OWNER ADDRESS 10 New Holland Road TEL 5082216636 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 NT _
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 accur t 'the b of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi al erti 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