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HomeMy WebLinkAboutBLDP&G-17-006736 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Tara CITY South Yarmouth MA DATE 06/12/2017 PERMIT# fir/7 4'1 JOBSITE ADDRESS 15 Widgon Road OWNER'S NAME!Stephen Bradford POWNER ADDRESS 15 Widgon Road a TEL 5082748267 __, FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL j RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:fl PLANS SUBMITTED: YES __.1 NO,' FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ;_ —, _______7_..._,,_ --br-- ._.�n__ ;: CROSS CONNECTION DEVICE ¢1 — DEDICATED SPECIAL WASTE SYSTEM P. DEDICATED GAS/OIL/SAND SYSTEM — DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM '-__I- DISHWASHER DRINKING FOUNTAIN L- ; FOOD DISPOSER — a FLOOR/AREA DRAIN _. INTERCEPTOR(INTERIOR) - KITCHEN SINK �a _ _ t LAVATORY , ROOF DRAIN — —SHOWER STALL _ _ SERVICE/MOP SINK TOILET _ URINAL ' WASHING MACHINE CONNECTION — WATER HEATER ALL TYPES I i Ti_ - j i WATER PIPINGS — OTHER ! _---'` --, i 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 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: 9WNER 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 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 corn h all inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Phillip Durfee LICENSE#113774 1 SIGNATURE MP JP _ CORPORATION PARTNERSHIP®#L_ LLC i j# 3152 COMPANY NAME Durfee Plumbing&Heating LLC ,ADDRESS, 12 American Way Unit 1 CITYLSouth Dennis !STATE' MA t ZIP 102660 TEL 508-619-3078 FAX [508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;sales@durfeeplumbing.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK sjiariM CITY South Yarmouth MA DATE 06/12/2017 PERMIT#j e4P,)7—c6 7% JOBSITE ADDRESS 15 Widgon Road OWNER'S NAME Stephen Bradford OWNER ADDRESS 15 Widgon Road TEL 5082748267 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 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: OW�IfR 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 accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn e h all. erti ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUMBER-GASFITTER NAME Phillip Durfee LICENSE# 13774 l SIGNATURE MP MGF JP JGF LPGI 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