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HomeMy WebLinkAboutBLDP-19-002942 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,ifil CITY West Yarmouth MA DATE 10/30/2018 PERMIT# /j4d P 9.00,9Y1 e�? JOBSITE ADDRESS 126 Hidden Acres OWNER'S NAME Orain Hall I POWNER ADDRESS !:same I TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL .j EDUCATIONAL © RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:Ti PLANS SUBMITTED: YES❑ NO❑ FIXTURES- FLOOR—F BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB r ir—_ r—. jI I 'l Ir._ — �� CROSS CONNECTION DEVICE - ' F-1 4- DEDICATED SPECIAL WASTE SYSTEM DEDICATED G /SA SYSTEM _1 1 _ r I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ]r =6 ]L I IL 1 - DEDICATED WATER RECYCLE SYSTEM ';r 1l .. f DISHWASHER D - IL, ._. —__ DRINKING FOUNTAIN I ti _. .-I 1 -ii FOOD DISPOSER FLOOR/AREA DRAIN rI 1-s-- . ir— ir: .—I— INTERCEPTOR(INTERIOR) F -1 1 11 I____ E T -FT KITCHEN SINK LAVATORY -a' r' ,- — ROOF DRAIN . .- _. a-.v... SHOWER STALL I1 _ SERVICE/MOP SINK m I __ tJ I.k,_.._ I TOILET f;_ _ a_._._. II.� 1 t- ' _____1_1 WASHING MACHINE CONNECTION URINAL —II—I �I 1— ! t, _ �;---_-I WATER HEATER ALL TYPES 1 - -11--- ( jr WATER PIPING 71 OTHER _� --fir 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 0 OTHER TYPE OF 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 U AGENT 0 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j¢ram c� /�Ai PLUMBER'S NAME Tygue S Reed I LICENSE# 15200 _ __ _ U SIGNATURE MP[A JPD CORPORATION0# PARTNERSHIP®#— LLCD# 4047C COMPANY NAME Coastal Mechanical ADDRESS 299 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 I FAX 508-760-5800_1 CELL 508-246-9959 EMAIL lisa©coastalphc.com -\ SOUTH SHORE HEATING & COOLING, INC. 57 White's Path r.1 � SERVICE WORK ORDER SOUTH YARMOUTH, MASSACHUSETTS 02664 ,11ft t 1,l, 1 S 75720 (508)398-690 , O u 1 t /r,Cj I D # BILL TO � POLICY EQUIP. EQUIP. NOTES KEY NAME DATE / BOILER CONDENSING FURNACE �0 � {f� METHOD OF PAYMENT GAS OR OIL UNIT GAS OR OIL STREET 614` t DAT ORDERei� �tf J1`u_/�_ �s COD Charge Replaced Unit Replaced Unit Replaced Unit I CITY PROMISED Replaced // t �/kineti th Cash Check Cleaned Cleaned ,C./t !�7 Compressor PHONE CALL BEFORE ❑ A.M. CI P.M. Previous Service Calls Draft Over Fire Oiled Motor Draft Over Fire TECHNICIAN f"� AUTHORIZED BY �� Draft Breech Changed Motor Draft Breech WORK TO BE PERFORMED i Smoke Checked Charge Smoke gr iaet. ems, Mo 4z)✓' . CO 2 Add Freon CO 2 Qty. MATERIALS DESCRIPTION OF WORK DONE Net Stack Cleaned Coils Net Stack ial;',G‘" � ��d 0, Efficiency Repaired Leak Efficiency r ! Replaced Replaced /tCjlJl1J 1� t /h, Smoke Pipe Replaced Fuse Smoke Pipe 70 Replaced Replaced ✓ 7{�rf �.«-�.I .../ 70 Thermocouple Repaired Wiring Thermocouple Co` ( / i Ca i 1^ .`p` Replaced ( cltr Wl fS Pump Pressure Pump Pressure d Fa rn tam Contactor (,# ,r 6 ' �+ Peplaced Checked Replaced / ,5 S,/ C Gol�orq Ee_ /CF.I1yc Nil Strainer Contactor Oil Strainer Oiled Replaced Relay Check ro ),/ /4(�,, Wien/ 2,-- /1 �, Circulator Fan/Limit p p Replaced Replaced Replaced Tvv'e, ed 6-es ( !- 4-0 l 4 Circulator Capacitor Gas Valve Replaced Suction Cleaned Burners �•j,,,a. copped. 7-u/sa/,7, Gas Valve Checked Head Changed Motor J/�� Tate N 4lijr" Ignitor Primary TR Cleaned Blower ,r.,+ r3 con Z do Control 1 ENVIRONMENTAL CHECK LIST RECOMMENDATIONS CONDENSATE DRAIN Volts Lit Pilot Rep WORK PERFORMED QTY. TYPE/DISPOSITION e_,h' 4 e t/7 • -I CheckedDrain Amps Winn red g 1 ❑RECOVERED / W ❑RECYCLED Cleaned Drain EVAPORATOR Replaced COIL Transformer ❑RECLAIMED �7 17.17) '9 ,6 i 4 SOS. 5 ri 0 p Checked Pump Replaced Unit Checked Ignitor . ❑RETURNED /T[.frr Checked ❑DISPOSAL ),,ip,tk;y,,s — Cw O\f v+s Replaced Pump Repaired leak Primary Control ❑DISMANTLED TOTAL 6 771/ -S/y _'95-0 Check/Clean Pan Seal HUMIDIFIER ❑CHANGED OUT/REPLACED LIMITED WARRANTY: All materials, parts and Replaced Cleaned TERMS equipment are warranted by the manufacturers'or Exp.Valve suppliers'written warranty only.All labor performed Cleaned Coil Replaced Pad by the above named company is warranted for 60 OUR TERMS ARE NET 15 DAYS days or as otherwise indicated in writing.The above Replaced PVC Check Float named company makes no other warranties, &Auto Feed express or implied,and its agents or technicians are Ent.Temp. Adjust I have authority to order the work outlined above which has been satisfactorily completed.I agree that not authorized to make any such warranties on Water Level Seller retains ktle to equipmenUmaeregru s furnished until final payment is made.If payment is not made behalf of above named company.as agreed,Seller can remove said equipment/Seller.als at Seller's expense.Any damage resulting fromLeaving Temp. Checked Motor said removal shall not be the responsibility of Seller. C',REGULAR F. WARRANTY T.D. ❑SERVICE CONTRACT /� r/� FILTERS ❑Cleaned H Replaced CUSTOMER SIGNATURE DATE 7hQ12 i2 (YOU! . '. 1 y ate: mom.,»- A - :.r - :, . .;z�:s.T.r,. :... -\� - � •:.:::ii' �\�--, ;• :�; K� :ii•�,` , looserr A<-. - :fie \ six.-:,x% • v` ., ` - -: - - . • . - ?tom: ` - 'Y•4a .M g,. 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