HomeMy WebLinkAboutBldp-19-006150 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
r s1; •—_
mv '� " CITY YARMOUTH MA DATE 04/26/19 PERMIT#/ �h'/�`0Q 6��
JOBSITE ADDRESS 11 HIGHBANK RD 1 OWNER'S NAME DELIMONTE
0.
P OWNER ADDRESS 11 HIGHBANK RD TEL 781-572-5572 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOQ
FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I I
CROSS CONNECTION DEVICE ;
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM I!
DEDICATED GREASE SYSTEM
DEDICATED GRAY W'T2 SYS I t
DEDICATED WATER ' v.3YSTC
DISHWASHER n '`�
J ^ �'
DRINKING FOUNTAIN I'
FOOD DISPOSER Q
FLOOR/AREA DRAI W w r
INTERCEPTOR(INT:' c.,,, I ,
4
KITCHEN SINK ,z � �; � , . I it 1 '
LAVATORY �1 _� I
ROOF DRAIN re L 1 n '
SHOWER STALL �--
i 1 I
SERVICE/MOP SINK
TOILET I I ,
URINAL I
WASHING MACHINE CONNECTION l
WATER HEATER ALL TYPES ) 1
WATER PIPING
OTHER ) i 1
I
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 ,r❑ OTHER TYPE 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.
CHECK ONE ONLY: OWNER ❑ AGENT LI
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¢ept of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with)all Pertin�`(t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (_ -"a_____ 1, --G...___
PLUMBER'S NAME JAMES CARABITSES LICENSE# 11156 SIGNATURE
MPO JP❑ CORPORATION LP 3759 PARTNERSHIP❑# LLC0#
COMPANY NAME ARS BOSTON ADDRESS 300 MANLEY STREET
CITY WEST BRIDGEWATER I STATE MA 1 ZIP 02379 , TEL 508-588-9025
FAX 508-558-1059 CELL I EMAIL
/tee//
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT# Ofr
PLAN REVIEW NOTES ( `
�� II
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
evf=, CITY YARMOUTH MA DATE 04/26/19 PERMIT#(egdP-/?'sdd(s0/w
JOBSITE ADDRESS 11 HIGHBANK RD OWNER'S NAME DELIMONTE
GOWNER ADDRESS 11 HIGHBANK RD TEL 781-572-5572 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD
APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER II
CONVERSION BURNER LI I 11 I
COOK STOVE
DIRECT VENT HEATER (J J I 1
DRYER l I
FIREPLACE ® ,- 1 1
FRYOLATOR Ili III e-r% - U i I I !
FURNACE GENERATOR >IV!,c �•MIN mini 111111111111111 miff nu. a INN�'i
GRILLE w t.cc.,. ., ;L MINI 111111111111 1111111
INFRARED HEATER ' 0 mul mi'I 11111Foggi micumgmiimumg mintmg min.
LABORATORY COCKS lid a VII I nom 11111111111111.1111111111111 ME MIN MB pm! E NM
MAKEUP AIR UNIT _ 1 1
OVEN a JUNI ONE MI MIMI MIK 111111111',IIIIIIII 111111111111111111I 11111111111111011 MAN M M'.
POOL HEATER I 1 j I
ROOM/SPACE HEATER 1, I
ROOF TOP UNIT III _ �I11
!- -- 11 1
TEST1 i
I
UNIT HEATER (�
UNVENTED ROOM HEATERI I 1 ��
WATER HEATER 1 t
OTHER ! I ! 1
,1 I u 1 it
I
I ii I i I I,
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE 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.
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 bb�st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertingrct,provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Lff_.(_-
PLUMBER-GASFITTER NAME James Carabitses LICENSE# 11156 SIGNATURE
MP❑ MGF❑ JP❑ JGF❑ LPG(❑ CORPORATION Q# 3759 PARTNERSHIP❑# LLC❑#
COMPANY NAME: ARS Boston ADDRESS 300 Manley Street
CITY W.Bridgewater STATE MA ZIP 02379 ITEL 508-588-9025
FAX 508-588-1059 CELL EMAIL
(/1'l, *
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT# /1A) 62l'1
PLAN REVIEW NOTES (//"t
77g./.7/;2
Aft—