HomeMy WebLinkAboutBLDP-19-000889 t, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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__ W CITY Yarmouth MA DATE 8/15/2018 PERMIT# e40/999—O61° 7
JOBSITE ADDRESS 66 Whites Path OWNER'S NAME Legeyt
P OWNER ADDRESS same TEL FAX
TYPE OR ' OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL .❑
PRINT
CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑+ PLANS SUBMITTED: YES 0 NO❑+
FIXTURES 1 FLOOR-, BSM 11 2 3 I 4 I 5 67 8 9 10 11 12 13 14
BATHTUB i
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM t ,
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM _ __
DEDICATED WATER RECYCLE SYSTEM J
DISHWASHER
DRINKING FOUNTAIN - ° -1 v - l tr
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) tr
KITCHEN SINK
LAVATORY - -- - - -
ROOF DRAIN
SHOWER STALL _ '
SERVICE/MOP SINK -C t- i -1 t.I.L E, 1
TOILET ; r- -- --- _---- i
URINAL _ , : I
WASHING MACHINE CONNECTION Ali - 4 Ll• 0 I
• WATER HEATER ALL TYPES 1 1
WATER PIPING d -_ till U Nun PARKi MI I 1
•
OTHER L . — :---- . 1
i I 1 -
•
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES O NO ❑
1
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
1 LIABILITY INSURANCE POLICY❑+ OTHER TYPE OF INDEMNITY❑ 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 pennft 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 :-:. : e to the best o knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In •.• i . ii.p.- - i .6 o of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Charles Stockdale LICENSE# 24526 SIGNATURE
MPO JPO CORPORATION 0# PARTNERSHIP❑# LLCQ#
COMPANY NAME Charles Stockdale ADDRESS 256 Mayfair Rd.
CITY S.Dennis STATE MA ZIP 02660 1 TEL 508-398-2843
FAX CELL 508-208-1613 EMAIL
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
Nr CITY Yarmouth MA DATE 8/15/2018 PERMITS /540P5)-0007 • I
JOBSITE ADDRESS 66 Whites Path OWNER'S NAME Legeyt
GOWNER ADDRESS same TEL 1 FAX_
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONALRESIDENTIAL❑+
PRINT ❑
CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO❑+
APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER I
CONVERSION BURNER 1 y d I
COOK STOVE T _ h
DIRECT VENT HEATER # I I
DRYER l J d i
FIREPLACE
FRYOLATOR -
FURNACE - 1 - , I
GENERATOR
GRILLE —_ '_ �_ I_ _
INFRARED HEATER I I - �
LABORATORY COCKS
MAKEUP AIR UNITI i
OVEN I ='I
POOL HEATER r a t...; C 0.- 14 i
ROOM/SPACE HEATER # I - f
ROOF TOP UNIT 1 •�
TESTI 1. r1SZ 14 CUItl
UNIT HEATER t, r y
UNVENTED ROOM HEATER rl F M "u. Di DhP ran/ 1r tIT I
WATER HEATER 1 J — .1 _ i
OTHER -I- - I
I 1
I t 1 1 I
INSURANCE COVERAGE
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO 0
I IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY ❑' 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 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 a. :- of .y knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in co.-.is I ce .' yyiyy on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4zj // j►—
PLUMBER-GASFITTER NAME Charles Stockdale LICENSES 24526 SIGNATURE
MP El MGF❑ JP JGF❑ LPGI❑ CORPORATION DI PARTNERSHIP OS LLC OS
COMPANY NAME: Charles Stockdale ADDRESS 256 Mayfair Rd.
CITY S.Dennis STATE MA ZIP 02660 TEL 508-398-2843
FAX CELL 774-208-1613 EMAIL
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