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HomeMy WebLinkAboutBLDP&G-20-002121 • '- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 'r •_,^,10= A: f- CITY Yarmouth MA DATE 10/15/19 I PERMIT#R -0002/02( ti JOBSITE ADDRESS 63 North Main St OWNER'S NAME Donald Meyer 1 POWNER ADDRESS TEL FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL -1 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ' PLANS SUBMITTED: YES NOn FIXTURES Z FLOOR BSM 1 2 3 E © 6 7 8 9 10 11 12 13 14 BATHTUB __— —Mil__��_��_�� CROSS CONNECTION DEVICE MIMI.� DEDICATED SPECIAL WASTE SYSTEM _--� �I����ii DEDICATED GAS/OIL/SAND SYSTEM umIl —_111111111111111111111111111 IIIIIIIIIII DEDICATED GREASE SYSTEM MINI 11111.11111111.1. DEDICATED GRAY WATER SYSTEM MIN M Mr ISMDEDICATED WATER RECYCLE SYSTEM - -- ®MIN _� =DRINKING FOUNTAIN INN IIIIIII■■�DISHWASHER n ■■ FOOD DISPOSER MEM��_ FLOOR/AREA DRAIN ___EMI�_���_����� INTERCEPTOR(INTERIOR) ---NMI MI KITCHEN SINK MI IIIIIIIINIMMill LAVATORY M__IIMIROOF DRAIN __ SHOWER STALL �■■OM ®■� ■■■ SERVICE/MOP SINK _-111111; .111_— TOILET 1111111 ___ URINAL M-11111I1.111111����_���_ WASHING MACHINE CONNECTION r— ■ -IT-- WATER HEATER ALL TYPES 1 OWATER THER PIPING .■.IN ■■■■■■■��■■ IIII INSURANCE COVERAGE: I have a current Iiability_i.nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES r/ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' 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 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - . PLUMBER'S NAME Richard Farrenkopf 1LICENSE# 33051 i IGNATURE MP D JP 0 CORPORATION L#I PARTNERSHIP®# 1 LLC #i COMPANY NAMELF Farrenkopf III P+H ADDRESS r41 Riverdale South CITY South Dennis ,STATE MA 1 ZIP 02660 TEL 5083603175- ., 9 i x. _ FAX j CELL EMAIL richardfarrenkopf@yahoo.com 1 IQ • • • Ot, „ . .: _. Yl a t w.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK —TA CITY Yarmouth MA DATE 10/15/19 PERMIT #j9� 2111 JOBSITE ADDRESS 63 North Main St OWNER'S NAME Donald Meyer GOWNER ADDRESS TEL FAX PRINT R OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL 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 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER 1 �INSURANCE COVERAGE I have a current liabiliinsurance 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 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 F lumbing Code and Chapter 142 of the General Laws. ate, PLUMBER-GASFITTE R NAME Richard FArrenkopf LICENSE # 33051 SIGNATURE MP MGF JP JGF LPG' CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: R Farrenkopf III P+H ADDRESS 41 Riverdale South CITY South Dennis STATE MA ZIP 02660 TEL 5083603175.,- -- -- FAX CELL EMAIL richardfarrenkopf@yahoo.com OCT 15 2619