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HomeMy WebLinkAboutBldp-18-004403 I i ga-,f8-00/- \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 Ai, 6 CITY YARMOUTH MA DATE 2/5/18 PERMIT# BLDP-18-004403 7. =fir rJOBSITE ADDRESS 476 ROUTE 28 OWNER'S NAME THE POINT LLC P OWNER ADDRESS 476 ROUTE 28 WEST YARMOUTH, MA 02673 TEL Q 63=ego/ TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ � -,q/y.�d ,, PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO FIXTURES .1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 35 35 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM '751401 DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM c� DEDICATED GRAY WATER SYSTEM P) DEDICATED WATER RECYCLE SYSTE R DISHWASHER DRINKING FOUNTAIN - FOOD DISPOSER • ' {' FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 58 58 I� ROOF DRAIN �� SHOWER STALL 24 24 7--:SERVICE/MOP SINK 41 TOILET 58 58 URINAL WASHING MACHINE CONNECTION 404 WATER HEATER _ 4ii"�WATER PIPING 1 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© NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY 0 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'S NAME Robert Wilder LICENSE#6244 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Wilderplumbing Corp. ADDRESS 180 Tyler street CITY methuen STATE MA ZIP 01844 TEL 9786886961 FAX CELL EMAIL (.:.--R if ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY Yes No FINAL INSPECTION NOTES /`- THIS APPLICATION SERVE AS THE El El Z/4-../'y 2 /3 Z ., D DRAIT 2. ' PAC �� / /2b G/ FEES$ PERMIT# l--( : 2 s 4,4 PLAN REVIEW NOTES (cv- LeS, TU,74-6 Abe s 0,1-( ilail y/V //e-- 0 Ail,: 6 tril's s ..5,,- ear 0 Ali 0 of a,/ �.l 5' //C '-1 d/ f-� % p -.6. ow .frrl- im-rN 410, iG-211- 7 N9 V/6' (/41g /2 aC7- f d. /-0 W- .;/-tea M lle/t PAb ) tf r Eir(t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .€.;— G CITY/TOWN t\Ci\ MC-DLA- , .\ MA DATE e-.).--- \ \S PERMIT#diven- 752 JOBSITE ADDRESS -V ' Qv�<C. ' —01NNER'S NAME l pOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT: Ur PLANS SUBMITTED: YES❑ NO El 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR/AREA DRAIN 10 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY q ROOF DRAIN - SHOWER STALL SERVICE/MOP SINK / TOILET /5 URINAL WASHING MACHINE CONNECTION / WATER HEATER ALL TYPES WATER PIPING OTHER ijit,,ct S',,,L / INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YEd NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware at the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my s' nature on this permit application waives this requirement CHECK ONE ONLY: OWNER El AGENT ElSIGNATURE OF OWNER OR A ENT 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 Ind that all plumbing work and installations performed under the permit issued for this application will be' p'ance with all Pertinent provision of the Massachusetts State Plu big Code and Chapter 142 of the General Laws. 'LUMBER'S NAME >:-� (.r/;�r/w LICENSE#16 SIGNATURE uIPL JP El CORPORATION El# Oen PARTNERSHIP El# Lc El# COMPANY NAME ! -4,- ADDRESS/ J // r- ;ITY 07 G-- 3 Cr' et-. STATE d zi /eq q TEL 9175�SS6s.Zil?'0 'AX_,____ CELIlt2 3' ?%" S EMAI I 'i id e,i,--2JG-A,Z; , j, Gnp . _ ,,, t . r, T � C' ' \ - (i. . t -11:\ °‘ ,\. . k rIcl.,_ 7- N,\ , -; 1, (\l) , \ ')— )4 i\ -, --(N> k ' \ — - - ( .\ V (-.: c , -n MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ey / /, I Q� ©0 3772- _�- � CITY ram'M d CJT� MA DATE �a -��' C� PERMIT#/�,�1�11"�i'' JOBSITE ADDRESS LI 76 Moe it. 5f/Q115- Ir OWNER'S NAME J•✓ Pate( G OWNER ADDRESS C/WE Pe;trtl TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL,' EDUCATIONAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:Zr REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE f 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 7 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES�O ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY El BOND El 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 ❑ AGENT ❑ 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 co li nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE#144,29y SIGNATUR MP ID MGF❑ JP El JGF El LPG!El CORPORATION El# PARTNERSHIP El# LLC❑# COMPANY NA.Pir w��� �� ( ��IC� �� ADDRESS /ad Tyfet- CITY ()I Ue n STAT 8 ZIP 0/6 / a TEL Glf/"Kq‘/ FAX 1 —a(fdgT( CELL(223 43r-4/1 .5- EMAIL � X�'G�C.�Jf gr 04- ZW2- fr (4011_2 -11?ti _ -kiggito- / I SasMz/a --f/4 ?-7/0-N/ // bl1/490 -1/011 11.// r-f/P fi'/'7"v biqt j12/1t) /04d ,40 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 2/6/19 PERMIT# BLDP-19-004526 JOBSITE ADDRESS 476 ROUTE 28 OWNER'S NAME THE POINT LLC n OWNER ADDRESS 1476 ROUTE 28 WEST YARMOUTH, MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES 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 1 ROOF DRAIN _ SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 OTHER 1 OTHER DESCRIPTION:sewer rejecter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ElNO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E' OTHER TYPE OF INDEMNITY El BOND El 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#6244 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILDERPLUMBING CORP. ADDRESS 180 Tyler street CITY methuen STATE MA ZIP 01844 TEL 9786886961 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ ppair c' i1 DCDWIIT ,9/31/ FEES$ PERMIT# PLAN REVIEW NOTES Ft4t PL. c 7/1/I? 1