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Home My WebLink AboutG-12-591 January 10, 2014 In regards to the boiler replacement job started by the Lower Cape Regional Technical High School in April of 2012, at 1 Gannet Road, in Yarmouth Port: I,the owner of the residence, Benjamin Latimer, release them from completion of the job that was permitted. The job is to be completed by John Smith. Benjamin Latimer IvED jAN 10 21114 ;,ANG prPARTMENT . 4. . Il = MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM OAS FITTING WORK CITY l Yarrrhoutlh `'"- I, MA DATE I 3/L1177i J PERMIT CP-- $ql JOBSITE ADDRESS 1 ( CAA,Nc-C (LA. J OWNER'S NAME I ,1it hp GOWNER ADDRESS: I SAMI, I TEL IroIt, te3LLp9y3IFAX:I 1 TPRINT YPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL 0 CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑ FIXUTRES 7 FLOOR- Bsml 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BOILER I BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR • FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OWN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER R " CEI `dED INVENTED ROOM HEATER • WATER HEATER / 6 / ?riff � 2��2 • otilbe 9-�crrir 1 MEN 13v I have a currant liability insurance I or Its substantial INSURANCE COVERAGE p° equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0 If you have checked yEs please Indicate the type of coverage by cheddng the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the ee figesnalin the Insurance coverage required by Chapter 142 of the Massadettetts General Laws,and that my signature on this permit application wajin thI requirement SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 0 hereby very that al of the details and infomtatlon I have submitted(or entered)regarding this appNcatlon are true and accurate to the best of my Knowledge and that all plumbing work and Irotallallons performed under the permit Issued to this app icatlon will be H provlsbn of the Massachusetts Stats Plumbing Code and Chapter 142 of the General Laws. /4 / comP ts al PertinentPLUMBERGASFITTERRNAME: 14Wt . 0. ,;114, IUCENSENIN<4t I SIGNATURE �+ � k— COMPANY NAME:I tom. sea pcztv o-, J ADDRESS:13 n ,dlt.�s,o,�-kogc•,ov i. 1 cm: I f4A2utr4J ISTATE fa ZIp•I�,d-LA, g s-- I FM: I I TEL roti . 4s Z. 4r3o JCELL:I 1 EMAIL: 1 ruh.gtrt F7./a/k�/4 . L6 I MASTEFal JOUR EYMAN Er LP INSTALLER 0 CORPORATION 0 it PARTNERSHIP 0 CLI LLC 0 f 41 SiLON M3IAMI NV11 I JV183d: S :333 _ 0 0 11Wd3d 3111 SV S3A83S NO118318d8 SIN/ oN saA O O p O N N AINO 3Sf1331AAO 80.4 MO73i{' i //7//t DEVAL L. PATRICK GOVERNOR ( eat.. Yi//��h BARBARA ANTHONY UNDERSECRETARY OF OFFICE OF CONSUMER AFFAIRS AND TIMOTHY P.MURRAY Commonwealth of Massachusetts BUSINESS REGULATION LIEUTENANT GOVERNOR Division of Professional Licensure GREGORY BIALECKI Board of State Board Examiners of MARK R. KMETZ SECRETARY OF HOUSING DIRECTOR,DIVISION OF AND ECONOMIC DEVELOPMENT Plumbers and Gas Fitters PROFESSIONAL LICENSURE 1000 Washington Street • Boston • Massachusetts • 02118-6100 December 1, 2011 Cape Cod Regional Technical School 351 Pleasant Lave Avenue Harwich, MA 02645 Attn: Louis M. Colombo Jr, Plumbing & Gas Fitting Instructor RE: Ben Lattimer-#1 Gannet Road -Yarmouthport,MA. Dear Mr. Colombo, Your application to perform Plumbing and Gas Fitting work at the Lattimer residence in South Dennis has been approved by the Board. Work on this project shall be limited to the type of project lesson as explained in your submitted application. Included in this mailing you will find the original documents with the stamped approval. If you have any questions regarding this matter or if we may be of any further assistance,please do not hesitate to call. Sincerely, For the Board C7-4 Wayne E. Thomas Associate Executive Director Board of State Examiners of Plumbers& Gas Fitters t TPI FPHr1MF• IA171797_1118 FAV• 18171 797_9907 TTvlrnn• 10171 777 9n00, I.N...Il.........,,,,••, ...•.,u..l . . , . ,,. Commonwealth of Massachusetts _ = .zr,_ _ OFFICE OF CONSUMER AFFAIRS _ / ti =Se DIVISION OF PROFESSIONAL LICENSURE r,�j= A-7 The Office of the Board ofExaminers of A _ 11,,�� Plumbers and Gasftters \ . ,� • VOCATIONAL 239 Causeway Street, Suite 400 elyed SCHOOL Boston, Massachusetts 02114 PROJECT APPROVAL APPLICATION NOV 21 2011 State> xanuners of APPLICATION FOR APPROVAL AUTHORIZATION TO PERFORM"PLUMBINd'ISInillefs&Qs fitters WORK BY STUDENTS OFA STATE AIDED ALL DAY VOCATION,4L SCHOOL • A- 'THIS APPLICATION 1S TO BE SUBMITTED TO THE BOARD OF STATE EXAMLNERS OF PLUMBERS AND GASH nuts FOR APPROVAL PRIOR'TO LOCAL AUTHORIZATION OF THE PROJECT PLEASE NOTE: THIS APPLIC4TION IS NOT APPROVED UNTIL A BOARD STAMPED APPROVAL AUTHORIZATION IS RETURNED TO THE SCHOOL ADMINISTRATOR OR DESIGNEE. • LOCAL PLUMBING AND GASFITTING PERMITS and INSPECTIONS ARE REQUIRED Name of School 449E t2f ) 1GP66/D/t'ft.- Teel? ///o,9 $NODE Address .S7 / %C7g41T 1 /¢Xic- MC. 1 Nn2aw4119 . Telephone Lir0 8' 1/A ,). - yJr&bD aa&VS Has this lesson been approved by the local school administration? Yes "NNo ❑ (A COPY OF THE ABOVE LESSON APPROVAL MUST ACCOMPANY THIS APPLICATION.) Name of Licensee who is employed by the school as the Massachusetts Instructor/Department Head who will be Plumbing and/or Cas-fitting Permit Holder of Record for this Protect: Name: Oe!/ S h1. atomise Ji. Journeyman License No. / '2G t 4/ Address: /a_f H2/S]�/ A/✓ _Master License No. • /6—al C / c rv1U w/ch, M A • o.2.r Plunibi. , ,n Gasfirt n Department Head: (Signature equi ed) / ,, ?( I / t . (ha J Date: /O (7/ // 11 PROJECT APPROVAL APPLICATION 07 1 . 4 • .l iii OWN/School LESSON/PROJECT LOCATION INFORMATION tName and Address of Parties for whom work is to be performed: $EN 2.67rooF- - - / (-;4-N/Ynr /ego Yncemearhe far i Na me and Address of Project Lesson Location: 5,94).C• Typeof Project Lesson: (Briefly explain Plumbing fixture(s) and/or Gas-fitting fixture(s) appliance and equipment installation. Include: Types of materials to be used.] Z/IrSTnGL ,/Fitt N61 &AS BO a.54 1 /ND/E5C-T' WAT6,2 If Applicable to the Anticipated Project: I (A COPY OF THE LOCAL BUILDING PERMIT AND PLUMBING & GAS-FITTING BLUEPRINTS/DRAWINGS MUST ACCOMPANY THIS APPLICATION.) 1. Type of Building: Residentialew❑ Old❑ 2. Number of Stories: 1 [ 2 ❑ 3 ❑ 4 ❑ Other 5 f 3. Basement: Yes [�No ❑ 4. Main Sewer Source: Public ❑ Private (Septic) Other❑ 5. Main Potable Water Source: Public rivate (well) ❑ Other❑ 6.. How is the building to be occupied: Residential 7. What is the projected date to begin the Project?. yMmb,D • ////t r 8. What is the projected date of completion? t/ /Mb/ Students Shall perform work at the project lesson site accompanied by and under the direct supervision of an Instructor who is a Massachusetts licensed plumber and gas-fitter in the employment of and authorized by the Educational Institution of record In this document. PROJECT APPROVAL APPLICATION 07 2 • t• . ;.- Briefly Explain: (:11 Ilou is this Project Lesson intended to benefit the students of your Program? ,S r aDch/rs int ?/ P. , 5 fie 4112.1- GST hyt efibO a V 'Y_P ?arr_/c . - in/5Zek.c-i,vg, /1-'Y_'�_ ,c ,Bo/C.b-2 -.7:".O&,eaz- tM7 -!t N.5-4- E 6 S_-�/P_ f 4}A 7--- / F/Pi 4'6 /9 5 pry DB. Se- Cate,e/c&GtWGsl• (B) How will Students be permitted to participate in the Pro'ect Lesson? 57-406NT6 W/ LG Ago To Rig fl-t- w,1ze 1444)SE- Pbescr Sdn.eu,saw e9 f ' h1/96-7s-/e- PL.anr1 B2 • (C) What Grade Levels will Participate in the Project? / / a- (U) What is the Number of projected Students Per Plumbing/Gas Fitting Instructor at the Project Lesson Site? /D 7'D / Names of Additional Licensed Massachusetts�� Instructors for this Project: l �it /e/c.,r� f/// /77L Journeyman License No. 2,03I-1 9 Master License No. I i-,z • • 2. Journeyman License No. t� Master License No. 3. • Journeyman License No. Master License No. OFFICIAL BOARD USE ONLY :it 5�C��4 // APPROVEDBFAPPVOVED BY: F. `✓ AND 9 ANU REGULATIONS/ N / FQ~- CHECKED BY tOf DATE; / a-O 1---l f N DATE a- —/ G) VO FOR THE BOARD One LANEX M NERY R c PROJECT APPROVAL APPLICATION 07