The URL can be used to link to this page

Home My WebLink AboutBLDP-20-003266 -, - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �_®u�,= CITY South Yarmouth MA DATE 112/2/19 _ PERMIT# 4i �-."''� /.34 P JOBSITE ADDRESS 410 Pine Street,S.Yarmouth,MA 02664 OWNER'S NAME Shawn D.Johnson P OWNER ADDRESS 410 Pine Street,S.Yarmouth,MA 02664 TEL 508-958-1424, lumberM I FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL Lj EDUCATIONAL L i RESIDENTIAL Li PRINT CLEARLY NEW:LI RENOVATION:[I REPLACEMENT:L. PLANS SUBMITTED: YES[l NO FIXTURES Z FLOOR-. BSM J 1 2 3 4 5 6 7 j 8 9 10 I 11 12 13 14 BATHTUB r CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM .j 9' .. . <°, -, ,_..,... DEDICATED GAS/OIL/SAND SYSTEM r 3 DEDICATED GREASE SYSTEM ' r -MI � r-- DEDICATED GRAY WATER SYSTEM allOff DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN , s ..._ ..� FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR1111111011111111111111 KITCHEN SINK IIIIIMIIIIIIIFIIIIIIIIIMIIWIIIII 1111111111111.111 MINT11111WM. LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1111111101111110111111 MI INIVIIIMI NMI URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WOMMillill iiii ,^ f WATER PIPING OTHER , , 3I 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Lj OTHER TYPE OF INDEMNITY 0 BOND 0 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 0 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 accurat- . the bes - my know-dge and that all plumbing work and installations performed under the permit issued for this application will be in compliance it• . '--- •rov' oft' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �/ ' PLUMBER'S NAME Robert D Fratus,Jr. LICENSE# 11296 . �� I MP[ JP CORPORATION L # PARTNERSHIPL # .,., 1LLCL # COMPANY NAME BC Plumbing&Heating ADDRESS P 0 Box 873 CITY Brewster +STATE MA ZIP 02631 TEL clerical# 508-896-1878 FAX 508-896-9130J CELL 508-958-1424 EMAIL N/A w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =42. ' South Yarmouth 12/2/19 f ' CITY MA DATE PERMIT#/''�%%;- �� :9�&7 JOBSITE ADDRESS 410 Pine Street, S. Yarmouth, MA 02664 OWNER'S NAME Shawn D. Johnson GOWNER ADDRESS 410 Pine Street, S. Yarmouth, MA 02664 TEL 508-958-1424,plumber FAX N/A TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: El REPLACEMENT: ® PLANS SUBMITTED: YES El NO❑ APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _ _ FRYOLATOR FURNACE GENERATOR GRILLE -outside INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES EI 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 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. CHECK ONE ONLY: OWNER El AGENT El 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 o the best my know dge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al • ov. ' of t Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Robert D. Fratus, Jr LICENSE# 11296 MP❑x MGF El JP El JGF El LPGI El CORPORATION El# PARTNERSHIP❑# LLC❑# COMPANY NAME BC Plumbing & Heating ADDRESS PO Box 873 CITY Brewster STATE MA ZIP 02631 TEL clerical# 508-896-1878 FAX 508-896-9130 CELL 508-958-1424 EMAIL N/A Red &iv, 0-pc ) 1/11/ Tmfi 'gc(