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HomeMy WebLinkAboutBLDP-19-002097 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK fCITY YARMOUTH MA DATE 10/9/18 p0PERMIT# BLDP-19-002097 JOBSITE ADDRESS 12&14 ROSETTA ST OWNER'S NAME JOHNSON NANCY L TR P OWNER ADDRESS N L JOHNSON INVESTMENT TRUST PO BOX 342 HYANNIS,MA TEL 02601 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL IN PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO FIXTURES : FLOORS—, RSM 1 2 3 4 5 6 7 6 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 I 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© 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 JOHN O'CONNOR LICENSEI#1191 SIGNATURE • MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JACK O'CONNOR PLUMBING ADDRESS 15 JAN SEBASTIAN DR,UNIT A5 R HFATINf; CITY Sandwich STATE MA ZIP 02563 TEL FAX 5088887997 CELL 5088331424 EMAIL • _ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ DCDMIT • FEES S PERMIT# PLAN REVIEW NOTES re— • ,X C� t • 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 09,20' PERMIT# BLDP-19-002097 JOBSITE ADDRESS 12&14 ROSETTA ST OWNER'S NAME JOHNSON NANCY L TR G OWNER ADDRESS N L JOHNSON INVESTMENT TRUST PO BOX 342 HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL N PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:© 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 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS 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 liability 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 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 end Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JOHN O'CONNOR LICENSE# 11191 SIGNATURE MP© MCC JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JACK O'CONNOR PLUMBING&HEA ADDRESS 15 JAN SEBASTIAN DR, UNIT A5, CITY Sandwich STATE MA ZIP 02563 TEL FAX 5088887997 CELL 5088331424 EMAIL • • • N ` L 3/A7.1,7 S31ON MRIA321 NVId #111 3d $ :33d ❑ ❑1IIN213d 3E11 SV S3A2f3S NOI1VOIlddV SRL oN sail S31ON NOI1O3dSNI1VNId KINO 3SA U0103dSNI 2lOd 30Vd SH-11 S31ON NO11O3dSNI SVO HJfO21