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HomeMy WebLinkAboutBLDP&G-17-003440 f iL,/n/ /) 6=u) r/f/.S kfZov C"c,'7.lt r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ik, CITY YARMOUTH MA DATE 1/4/17 PERMIT# BLDP-17-003440 — JOBSITE ADDRESS 48 JERUSHA LN OWNER'S NAME FARQUHARSON HOWARD P OWNER ADDRESS 69 SHERIDAN CIR WINCHESTER, MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT: El PLANS SUBMITTED: YES❑ NO III FIXTURES 1 FLOORS—> 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE 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 1 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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. 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. PLUMBER'S NAME James Carabitses LICENSE#1156 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME James Carabitses ADDRESS 19 Mathieu Dr CITY Westborough STATE MA ZIP 015813560 TEL FAX CELL EMAIL _1- . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK vm0j _ CITY Yarmouth _ - MA DATE 12/30/16 ,PERMIT#/s-D/' 17— 1 j / JOBSITE ADDRESS 48 Jerusha Ln ' OWNER'S NAME Farquharson PIOWNER ADDRESS 48 Jerusha Ln i TELL 3392210071 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL U EDUCATIONAL Li RESIDENTIAL PRINT CLEARLY NEW: RENOVATION s REPLACEMENT:0 PLANS SUBMITTED: YES FA NO2 FIXTURES Z FLOOR-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _'; ,I_ I i I I ;_ 1I ,, _ II CROSS CONNECTION DEVICE ' ii DEDICATED SPECIAL WASTE SYSTEM 1 1 �— J € 4 1 DEDICATED GAS/OIL/SAND SYSTEM 1 _La: '101IFIEINT— J unitromm. ,____:, __ _ mr,____;1.,_____„,:____, „ __„____•1_,„ ;____ ..i,„.. ; ____;___„_,._ ._ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN IIIIIIMENSIMIIIIIIIIIMMINOMMINIRMIHNIII—MIM' NI' FOOD DISPOSER ._. FLOOR/AREA DRAIN NW ,— : "---I,--"mr,r----,,.------ ,:-- ,. ----, ! nr inn. INTERCEPTOR(INTERIOR) KITCHEN SINK ROOF DRAIN , n, Rai if .1 SERVICE/ 1 .. , TOILET URINAL NRIIIIIIIIINIMIIIIIIIIIIINIIIIIIIMOIIIIIIIIMIIIIIIFIOIIIIIIIIIIIIIIIRIIIIII WASHING MACHINE CONNECTION WATER HEATER ALL TYPES } NI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D 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: OWNER iJ AGENT Li 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 accurat he best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be• pliance with al rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 3 i PLUMBER'S NAME[James Carabitses LICENSE# 11156 SIGNATURE MPLI JP LI CORPORATION Li#[3759 ,, PARTNERSHIPLJ# LLC Li#I COMPANY NAME 1,ARS/Heatin &A/C Services ADDRESS 300 Manle St CITY W.Bridgewater iSTATE MA ZIP 02379 TEL 508-588-9025 FAX ,508 588 1059 CELL 1 EMAIL J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e w,, CITY YARMOUTH MA DATE January 04,201 PERMIT# BLDP-17-003440 JOBSITE ADDRESS 48 JERUSHA LN OWNER'S NAME FARQUHARSON HOWARD G OWNER ADDRESS 69 SHERIDAN CIR WINCHESTER MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW El RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NOE FIXTURES 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 OTHER DESCRIPTION: 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 © OTHER OF INDEMNITY El BOND El 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. 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. PLUMBER-GASFITTER NAME James Carabitses LICENSE# 11156 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: James Carabitses ADDRESS 19 Mathieu Dr, CITY Westborough STATE MA ZIP 015813560 TEL FAX CELL EMAIL c_. I; • '�"o MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK J CITY Yarmouth MA DATE 12/30/16 PERMIT# "/7 0c e/4/6 JOBSITE ADDRESS 48 Jerusha Ln i OWNER'S NAME Farquharson - .cv.:xr,H.nu OWNER ADDRESS Farquharson TEL 339-221-0071 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL '. PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-i 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 i'NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 and accurate t t e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ce with all P nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ( ' PLUMBER-GASFITTER NAME James Carabitses LICENSE# 11156 IGNATURE MP i MGF JP JGF LPG' CORPORATION i # 3759 PARTNERSHIP # LLC # COMPANY NAME: ARS/Heating&A/C Services ADDRESS 300 Manley St x—„ , CITY W.Bridgewater STATE MA ZIP 02379 TEL 508-588 9025 ,,,, FAX 508-5881059 CELL EMAILa„ .,� �- I - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ F CITY ;Yarmouth MA DATE 12/30/16 � z PERMIT# P/7-042�f/ JOBSITE ADDRESS!48 Jerusha Ln t OWNER'S NAME 'Farquharson OWNER ADDRESS I Farquharson � r� � TELL 339-221-0071 #FAX l_w TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL '1 RESIDENTIAL( PRINT CLEARLY NEW: RENOVATION REPLACEMENT. 1 PLANS SUBMITTED: YES NO 'I APPLIANCES 1 FLOORS BSA 1 2 3 4 5 6 7 8 9 10 11 12 13 l 14 BOILER BOOSTER I mi;- CONVERSION BURNER E COOK STOVE DIRECT VENT HEATER DRYERar� z. _ .m:� � .� " FIREPLACE FRYOLATOR FURNACE I _ I_ ;. ' y-_ AN GENERATOR YNISIIIOIIIIIIIMIIIIIIIOIIIIIIIMBIIIIIISIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII GRILLE INFRARED HEATER LABORATORY COCKS ti. _ . __. .. MAKEUP AIR UNIT OVEN 10.101111111011111111111111 NM ....... . . POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT TEST UNIT HEATER _ R _ UNVENTED ROOM HEATER monnamonenamiNE WATER HEATER 'initlialliellillatilliftNillill OTHER � .._ NW NIIIIIIMSMINSIIMilliallitIONIIIMININIIIIIII _ A . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ..' NO »ry I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L OTHER TYPE INDEMNITY L g BOND L,,,, 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 iji AGENT I .",; 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 a best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co e with all P nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. n� PLUMBER-GASFITTER NAME James Carabitses _j LICENSE# 11156~ ""yr GNATURE MP ± MGF JP J..J JGF LPG! CORPORATION J#=3759 1 PARTNERSHIP # iLLC E #L I COMPANY NAME:€ARS/Heating&A/C Services ADDRESS;300 Manle St ___ CITY ;W Bnd ewater _ STATE ZIP 508-588-9025 FAX 1 508-588 1059 CELLI µ KK��EMAIL n rta