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Home My WebLink AboutP-12-281 a IS., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ei CITY I Yarmouth ( MA DATE I !/flru !PERMIT;Pit: 2%t D JOBSITE ADDRESS 130 CLCUL(1- 4 cup/LK I OWNER'S NAME r OWNER ADDRESS:I ar 14- g0 Sami,UaY c—r ITEL:I9d33r7&534,FAXI I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDEN11AIitr PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENTS PLANS SUBMITTED: YES 0 NO❑ FIXUTRES 1 FLOORS sans 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE ,r..r,.__ DEDICATED SPECIAL WASTE SYS tig lit DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYSTEM NO7 Z9 2011 -I DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER BU WING DEPT DRINKING FOUNTAIN 2Z,___.— - FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES g'NO 0 If you have checked yeS,please indicate the type of coverage by checking the appropriate box below. LJABILITY INSURANCE POLICY OTHER TYPE 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 CHECK ONE ONLY: OWNER 0 AGENT 0 I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and aka to the best of my Knowledge and that all plumbing work and Installations performed under the perm*Issued for this application will be M co ce with all Pertinent provision of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAMCCE:I K. PETtR CHECKO WAY I UCENSE#1 /3€//7 I IGNATURE COMPANYNAMEi0 g01fER RISE& I ADDRESS: I CITY:I DtPiNIb,MA U2b3d I STATE: .300-303- furl DR I FAX: I .3e� –6e , I TEL: I I CELL:1551?-1,3Jr'r7?3 I EMAIL MASTER' JOURNEYMAN 0 CORPORATION 0#I I PARTNERSHIP 0#I I LLC❑#I I ?lam "INAG INSPECTION NOTES ROUGHaINSPECTION NOTES sFLOW FOR OFFICE USE ONLY Yes No THIS APyLICAT10N SERVES AS THE PERMIT 0 0 FEE: $ PERMIT II PLAN REVIEW NOTES r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING ,E y� ! �_=_ 14t : CffYITOWN:, /9�"0 OS I STATE:Mg APPLICATION DATE: Iii fig�/ I JOB ADDRESS: O C gp _. . I GOCCUPANCY TYPE: COMMERCIAL❑ RESIDENTIAL PLANS SUBMITTED: YES❑ NO El NEC ALTERATION': REPLACEMEN ik' REMOVALIDEMOLITION❑ 1- NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT-APPLIANCES-SYSTEMS 1 ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FNE(5)NUMERALS AIR ROTATION UNIT I—I FURNACE: ALL TYPES 1-7TEMP HEATING EQUIPMENT ^ BOILER:ALL TYPES T GAS PIPING 1----1THERMAL OXIDIZER BOOSTER —_I GENERATOR(STATIONARY ENGINE) l I TURBINE BROILER _1 ILLUMINATING APPLIANCE I- I UNIT HEATER BURNER: ALL TYPES ------1 INCINERATOR )-1 WATER HEATER: ALL TYPES I / CO-GENERATION UNIT -----1 INDUSTRIAL AIR HANDLER 3 I EQUIPMENT OVER 12,500MBH COFFEE ROASTER ---I. INFRARED HEATER — I rOTHER NOT LISTED? _ I COOK APPLIANCE HOUSEHOLD -- KILN I GLORY HOLE/CRUCIBLE I---II ttn I -----t I COOK APPLIANCE COMMERCIAL LABORATORY COCKS I I I! Cji Il ��I a DECORATIVE APPLIANCE —I MAKEUP AIR UNIT DIRECT VENT APPLIANCE I MECHANICAL EXHAUST EQUIPMENT n _ Nov 2g 7 1111 DRYER: ALL TYPES -----1 OVEN: ALL TYPES I-1 FIREPLACE:VENTED/UNVENTED — FIREPLACE:VENTEDIUNVENTED POOL HEATER I--1 DUILD'MnnFPT FRYOLATOR ROOF TOP UNIT I 8y FUEL CELL ROOM HEATER-VENTEDNENTLESS i 411•---) PLUMBING I GASFITTINGFIRM INFORMATION CHECK ONE ONLY NAME: rurnwGNTCilPf11EC�CTT rvev I ADDRESS: ] ['Corporation Business I Partnership Business I (- 11 SGARGO'HILL ROAf) --1 �7 CITY:l )STATE: MA ZIP:�� r Bciuiy�, i uL6414____. ________j_ LJLLC Business I TEL:b 508-385i'%t . I EMAIL: u� EOM/Unincorporated NAME OF LICENSED PLUMBER I GAS FITTER:R. PETER CHECKO.WAt4 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YESaNO❑ If you have checked yeal,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ET Other type of indemnity❑ Bond 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not hav@ the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application Sy=this requirement. CHECK ONE ONLY OWNER❑ AGENT ❑ Signature of Owner or Owner's Agent OWNER'S NAME: 1 RI71(141302 (Ar 'c\rJ ,J :� TEL3 all--5(134 I FAX I(- ^1 I hereby certify that all of the details and Information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws. (OFFICE USE ONLY) Type of License: Peml4# ,}E�Plumber ❑Gasfitter I Master ❑Journeyman Signature of L' Plumber!Gas Fitter Inspector 3" 7 -1 --`l ❑Undiluted LP InstallsLicense Number: i (- fee: ~ __ 1 0 Limited LP Installer