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HomeMy WebLinkAboutBldp-19-006751 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/30/19 PERMIT# BLDP-19-006751 JOBSITE ADDRESS 476 ROUTE 28 OWNER'S NAME THE POINT LLC P OWNER ADDRESS 476 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES i FLOORS— 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 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 12 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Robert Wilder LICENSE 1I1.16244-M SIGNATURE MP © JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILDERPLUMBING ADDRESS 180 Tyler Street CORPORATION CITY Methuen ( STATE MA ZIP 01844 TEL 9786886961 FAX CELL 6032344035 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES • Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `, CITY YARMOUTH MA DATE May 30,2019 PERMIT# BLDG-19-006750 If JOBSITE ADDRESS 476 ROUTE 28 OWNER'S NAME THE POINT LLC G OWNER ADDRESS 476 ROUTE 28 WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ 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 I SPACE HEATER _ _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 12 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER 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. 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-GASFITTER NAME Robert Wilder LICENSE# PL16244-M SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Wilderplumbing Corporation ADDRESS. 180 Tyler Street, CITY Methuen STATE MA ZIP 01844 TEL 9786886961 FAX CELL 6032344035 EMAIL c ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES• 4 Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE: $ PERMIT# PLAN REVIEW NOTES tip 0,- 1---- \ e-- ( ) ( RS: 6/672fLA--e;g1L-/ : : zu J2..0,31&- 7/ailz tt.c,re k 6 2_67 ,Reji2AiL,e_, `( i Celt //)01:5?1-14--, Enn .1 Vitotrq ' AP' .7&- --4,4v 2._›--, 4/Wysthi, kiudt719 676-- tAx&----V-0 It-19 _ 66.- -1? l.,4, / ' flAAA7E4-----.4ttk. A f ii.),0 fs2A t..t.'N td IL S--22-0 t,4 ,.' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ';-11------,: i3„r mov h MA DATE ! &/�/9 PERMIT#/ , OO575V cITY JOBSITE ADDRESS Li 1 M°- h STCe LT OWNER'S NAME.-Z-&r r i-1 464 4 fic Q;,UI.4 P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB -. _ CROSS CONNECTION DEVICE IV . DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM - , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ _ _ DEDICATED WATER RECYCLE SYSTEM 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 ALL TYPES (O Y' WATER PIPING - . OTHER INSURANCE COVERAGE: _f I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ly NO ❑ IF YOU CHECKED YES,PLEASE INDICATE TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY [ 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. CHECK ONE ONLY: OWNER 0 AGENT ID SIGNATURE OF OWNER OR AGENT 1 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 040ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , 3 (/G/ 1 /� 7 PLUMBER'S NAME LICENSE# l3 y C'7 7 SIGNAfURrE( MP d JP 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME G r Ea') f zio 1 o Li CO OOQp*S aC ADDRESS 1 6etyvceo., 3Tr-ee..7 CITY NArsh j/e/d STATE l ZIP 05 D TEL 7 / 8 3 Y b o 7 FAX 7`ti @31/6ao 9 CELL ??/abLfs`l yr EMAIL a.4_ ., • -_Y .- IZ. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' CITY: `�ar vf� Mk DATE: I/ASY/9 PERMIT#!1' ft&4Y JOBSITE ADDRESS: 17 ro 1)� i1 WOWNER'S NAME: S�m 5 a el N QJ' ,4/S . s, �- C. GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL[( EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:(( RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ -e= APPLIANCES-1 FLOOR-+ Bsmt 1 2 3 4 5 6 7 8 9 10 11 _ 12 13 , 14 BOILER Cp _ BOOSTER v CONVERSION BURNER ()� COOK STOVE 0.) DIRECT VENT HEATER d DRYER L FIREPLACE . FRYOLATOR FURNACE . GENERATOR GRILLE _ VI INFRARED HEATER W LABORATORY COCK , - _ _ MAKEUP AIR UNIT 4 .OVEN _ . POOL HEATER ROOM/SPACE HEATER S J ROOF TOP UNIT _ TEST .Z UNIT HEATER _ r,U UNVENTED ROOM HEATER _ WATER HEATER , INSURANCE COVERAGE � I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES LZd NO 0 If you have checked na,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY III 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 CHECK ONE ONLY: OWNER 0 AGENT [:c) SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this appkc ation are true and accurate to the best of my Knowledge and that all plumbing wok and installations performed under the permit issued for lids appin will in•e..•E ante with ail Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFiTTER NAME: r tee' - i3,�J O. UCENSE# 17 -i-I-J SIGNATURE COMPANY NAME: Gam,,lane r em Cad‹16"ADDRESS: `t Z V ip-xtJ 5TT y l'filly-e/h CITY: i'-'•,...--c d STATE:K-0 ZIP: OAOG ) FAX 1g1 - e3 Laos TEL: "N)- %3%Do 1 CELL: $i- bN -C`l 1111 EMAIL' rek4c r i 114 ()Q.crnc a s-i- i MASTER Cr JOURNEYMAN 0 LP INSTALLER❑ CORPORATION[�# 3 I S PARTNERSHIP 0# LLC 0# E M/Vc. Rb7,tieeSs: 4 V