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HomeMy WebLinkAboutBLDP-18-005559 I.0 "•-•.y 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i,•; CITY YARMOUTH MA DATE 4/5/18 PERMIT# BLDP-18-005559 1/4�I' JOBSITE ADDRESS 72 CAPT BACON RD OWNER'S NAME Weea-e*RR4E-II.IT/5 *stm P OWNER ADDRESS 72 CAPT BACON RD SOUTH YARMOUTH, MA 02664TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS-. SSM 1 . 2 3 4 5 A 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 m NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY m 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. 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 Michael Mcbride LICENSE#9681 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 19 NIGHTINGALE DR CITY S YARMOUTH STATE MA ZIP 026641825 TEL • FAX CELL EMAIL 6 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES �^ Yea No a THIS APPLICATION SERVE AS THE 0 0 eonurr FEES S PERMIT PLAN REVIEW NOTES S. ' ` _1 • j - MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK ,,,/ .ild0 CITY 5 t7,- Yc Htj a r)(-€1 MA DATE . Y A 4 € PERMIT#714P-A'OD.SSS9 JOBSITE ADDRESS .7 •7 cell Pr (3i c_r&iO) OWNER'S NAME _ a ,. POWNER ADDRESS TEC/7Y7T1-0128 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:I. PLANS SUBMITTED: YES 0 NO prj FIXTURES 1 FLOOR-, ' 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 SYSTEM . DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER - - FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) - _ KITCHEN SINK LAVATORY . ROOF DRAIN •• I SHOWER STALL • SERVICE/MOP SINK I TOILET URINAL • 1 WASHING MACHINE CONNECTION r • i WATER HEATER ALL TYPES WATER PIPING I OTHER . INSURANCE COVERAGE: . n I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL . x. *Z. ,!4 a IF YOU CHECKED YES,PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELO N APR 04 2018 LIABILITY INSURANCE POUCY e OTHER TYPE OF INDEMNITY 0 BOND 0 _ _ i CV B . LD N E AR M NT OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requ red y Chapter 2of the___ 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement • l. CHECK ONE ONLY: OWNER 0 AGENT 0 1. SIGNATURE OF OWNER OR AGENT Li 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 al 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 LICENSE# I7kr( CSIGNATURE�� MP ❑ • JP Vl. CORPORATION❑# PARTNERSHIP 0.# LLC❑# R roP COMPANY NAMEit cit. P ADDRESS / V1WU^e_ 4,e/ti--e CITY 5 Dcc. NA/Lori-Ai STATEt(JA— ZIP (' y TEL 9 7f <740 7/�2Z FAX • CELL EIsAAI L' [/I PJ` • M CA C t Ip p. pf-uit L '(as ROUGH PLU11'IBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMITS PLAN REVIEW NOTES • J a - ,,_a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , CITY YARMOUTH MA DATE April 05,2018 PERMIT# BLDP-18-005559 JOBSITE ADDRESS 72 CAPT BACON RD OWNER'S NAME WOOD CRRRIE C#,ZI570/02_ hpEk4(,L4 G OWNER ADDRESS 72 CAPT BACON RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL Ill PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:❑ TN.art -oo7 PLANS SUBMITTED:YES❑ NOD 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 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER 0 1 LABORATORY COCKS 17\ 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 Jiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES © NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El 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 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 102 of the General Laws. PLUMBER-GASFITTER NAME Michael Mcbride LICENSE# 19681 SIGNATURE MPO MGF❑ JP© JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS 19 NIGHTINGALE DR, CITY S YARMOUTH STATE MA ZIP 026641825 TEL FAX CELL EMAIL S31ON M31A3a NV-Id #IIW213d $:33J ❑ ❑11W213d 3H1 SV S3A213S NOLLVOIIddV SIHI ON saA SWION IIjO1103dSNI 1VNId AINO 3Sf1 lO103dSNI NOd 30`dd SIH1 S31ON NO1103dSNI S10 HOfON MASSACHUSETTS UNIFORM APPLICATION FOR AEE ITT PERFORM GAS FITTING WORK =sem;' �- • =_ CITY : o `/ MQ�,[�`� _4 —I MA DATE �PERMR#BV PO-a- O0' f JOBSITE ADDRESS!-72_ C-fpZ cc,., al OVVNER'S NAME Cfrir5 /n 3 tir GOWNER ADDRESS i � — I TEC 77y zs/ O(7 SIFAXI f TpT OCCUPANCY TYPE COMMERCIAL;^( EDUCATIONAL_] RESIDENTIAL U CLEARLY NEW:J RENOVATION:1 REPLACEMENT:,SU PLANS SUBMITTED: YESj,0 NO lia APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ____I J.. J ' I .___J-1-j J -J-1 BOOSTER I -J-1.-I . i.•-J ...- -1 i-J-J CONVERSION BURNER 1 Iii 1 I •_I_J;_i COOK STOVE —•1—J —J' —1 DIRECT VENT HEATER _j ._ _ I j_� J J DRYER- _1-1 -J - '-J -J-J FIREPLACE LJ_-J_J __LJ �__I_ _J t LII FRYOLATOR _ L__1__I -- --1 _7_.1 J FURNACE 1 - I .- 1f —1-J _f I GENERATORGRILLE I®—t—�® I!--J�_J—J—Jill= INFRARED HEATER LABORATORY COCKS a. eee UNIT HEATER an____I L_____I MEM___I___I a L_Jalla__Tall ' • WATER HEATER. -- — - �_I_LIME® ®S_J-_LJ. ' I I:-.JNI_____Ja a-.a 1-_J.__JS JJ�_ IaS_Illear i_- 1_'�SI�J_ _ISMASJ INSURANCE COVERAGE C I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES Il�NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 34 OTHER TYPE INDEMNITY 'J BOND [r 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 ,J AGENT T;1 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-GASFITTERNAME Ado ed fit,.pr,a-I LICENSE# ' , SIGNATURE MP 3 MGF:_1 JP t JGF ,,J LPGI_„f; CORPORATION j# PARTNERSHIP;.1# Yr r•- COMPANY NAME: t n t ADDRESS. - - ` - CITY , . D . A_ N/A 03 - • . ..- p- (. STATE( -}ZIP Q?f-�a�TEL'�/ OTej. /7 FAX' (CELL; • (EMAIL' + s APR 0 4 2018 PAI ,i,'- DEPA T 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# ELAN REVIEW NOTES • • • • • !_r-- '44,3`4:3 i1/47_1%:1kS : c•