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Home My WebLink AboutBLDP-19-002457 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,n Sow n ;2d CITY SOUTH YARMOUTH MA DATE 10/17/18 PERMIT#D-AP7P t '.y57 JOBSITE ADDRESS 138 CAPT NOYES RD OWNER'S NAME ROBICHAUD OWNER ADDRESS 138 CAPT NOYES RD TEL 508-775-3083 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:D RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOQ FIXTURES1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 555msf,5'inasc DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 5 ', _ nnnInS'..,_lmileali DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINKEnnranntratallia LAVATORY - — so ROOF DRAIN SHOWER STALL SERVICE/MOP SINKj�� ,�1 � �it��rj ��, TOILET URINAL WASHING MACHINE CONNECTION 11111011111111111/1111c , 111Mt . �11� WATER HEATER ALL TYPES fl.5"51•11111111alS OmmaimmareiSOMM. WATER PIPING . ;_, _55__]_5 OTHER 111111.111111111111111111111111_'5_i•Il��li�_.5,��_ �fll�1l�■I�fM�lt_lel��ll■�11F�iS55f�■1�'d��5. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY Q 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 ON, : 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 an, urate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in co plia = rtt - ent provisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , / (40'/.41 PLUMBERS NAME MARK MORAN LICENSE# 20786 " SI A URE MP ID JP El CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE CITY FORESTDALE STATE MA ZIP 02644 • TEL 508-648-2934 FAX - CELL 508-648-2934 EMAIL MORANPANDH .GMAIL.COM MARY• ROBIES.COM j-gu- J.CV' de 37)k ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 /, j/�/� FEE: $ PERMIT# /r� , "' /3 PLAN REVIEW NOTES /a��&/� MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK IE 3 1= CITY (S UO TH YARMOUTH— ! MA DATE! 10/17/18 I PERMIT# a-4,79-000195-7 JOBSITE ADDRESS: 138 CAPT NOYES RD OWNER'S NAME ROBICHAUD GOWNER ADDRESS 138 CAPT NOYES RD ,TEL 508-775-3083 FAX! TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PA PRINT CLEARLY NEW:J RENOVATION:', REPLACEMENT:a PLANS SUBMITTED: YES;.] NOa APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER r CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR • .` FURNACE GENERATOR --GRILLE — INFRARED HEATER LABORATORY COCKS T' MAKEUP AIR UNIT OVEN � POOL HEATER �i ! tfEATER MSACE H _ ! _' F OUNITL • 11 �O } iER ; — 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 Ia NO (❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a 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 ,U AGENT U 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 acc e to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in corn.is ->wi . I P-•' - provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / /A PLUMBER-GASFITTER NAME MARK MORAN 1 LICENSE it. - SIGNATURE MP ID MGF iJ JP la JGF J LPG,JJ CORPORATION]# — I PARTNERSHIP U# 1 LLC j#,^ COMPANY NAME:'MORAN PLUMBING&HEATING 1 ADDRESS 16 BRAMBLEBUSH DRIVE CITY FORESTDALE 1 STATE! MA IZIP:_02644 !TEL 508-648-2934 FAX 508-5341272 + CELLI 508-648-2934 (EMAIL MORANPANDH@GMAIL.COMI MARY@ROBIES.COM LP it Sib ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# pG�Z '' `� "�� " PLAN REVIEW NOTES Oft�' L" / III -