HomeMy WebLinkAboutBldp-19-006354 ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Ilf� CITY WEST YARMOUTH MA DATE 4/18/19 PERMIT#J D � l O
_
JOBSITE ADDRESS 82 ACRES AVENUE i OWNER'S NAME SMITH
pOWNER ADDRESS 82 ACRES AVENUE TEL 781-249 2165 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL ID
PRINT
CLEARLY NEW:El RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES ID NO
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/OIL/SAND SYSTEM ,... '
MI
DEDICATED GREASE SYSTEM ii
DEDICATED GRAY WATER SYSTEM 1
DEDICATED WATER RECYCLE SYSTEM I � ��� e. _.
DISHWASHER i►
DRINKING FOUNTAIN I f I
FOOD DISPOSER
G
FLOOR/AREA DRAIN ,F I
III
INTERCEPTOR(INTERIOR) I ,
KITCHEN SINK
LAVATORY ,
ROOF DRAIN 11 II Ill.
SHOWER STALL I
SERVICE/MOP SINK i ti- _ i I 11WIF , III!
TOILET
URINAL I 1
WASHING MACHINE CONNECTION WI
WATER HEATER ALL TYPES
WATER PIPING .
OT-... HER I Mill
k
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND Q
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 El AGENT El
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 rate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliant inent v' ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME MARK MORAN LICENSE# 20786 SI NA UR
MPEl JPE CORPORATIONE# PARTNERSHIPQ# ®LLCQ#
COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE
CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934
FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM
C,P
ROUGH PLUMBING INSPECTION NOTES BELOWFOR
OFFICE USE ONLY FINAL INSPECTION NOTES
i
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT# `"� O7
PLAN REVIEW NOTES
" ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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111— a CITY WEST YARMOUTh MA DATE 4/18/19 E PERMIT# �' r 015'/
JOBSITE ADDRESS 82 ACRES AVENUE OWNER'S NAME SMITH
GOWNER ADDRESS 82 ACRES AVENUE TEL 781-249-2165 I FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL __ EDUCATIONAL _ RESIDENTIAL.'
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: .,' PLANS SUBMITTED: YES m NO /
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
{ I
CONVERSION BURNER : ` ! .__ _.. ' ....' . , _
COOK STOVE : ? f
DIRECT VENT HEATER
i'
DRYER _ __ _ _ � _._ I__
FIREPLACE r
I t
FRYOLATOR w_-_° N -. , __ f . I .... 1 ; , _.
FURNACE
GENERATOR
i
GRILLE I i i _
INFRARED HEATER _
LABORATORY COCKS
MAKEUP AIR UNIT _ _.___ __ i
OVENF
POOL HEATER i :i _ _ a _._
ROOM/SPACE HEATER 1
ROOF TOP UNIT E
TEST
i ' _.._.,_I
UNIT HEATER __ l I'
UNVENTED ROOM HEATER
WATER HEATER 1 .
OTHER = _ ` ,
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES v NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i 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: 0 NER .._._w 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 acc to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia wi II P ' nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME MARK MORAN LICENSE# 20786 SIGNATURE
MP MGF JP i JGF LPG' CORPORATION # PARTNERSHIP _ # LLC # ''
COMPANY NAME: MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH
CITY FORESTDALE STATE MA `ZIP 02644 TEL 508-648-2934
FAX 508-534-1272 CELL 508-648-2934 :EMAIL MORANPANDH@GMAIL.COM 222 :22 2 2,, 2, ,_
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT El ❑ /',49
FEE: $ PERMIT#
PLAN REVIEW NOTES L��