HomeMy WebLinkAboutBldp-19-005931 `, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-: "11{_—>, CITY Yarmouth I MA DATE,04/12/19 PERMIT#//%'9 6V S 9 /
JOBSITE ADDRESS 30 Carter Rd OWNER'S NAME Mackay
GOWNER ADDRESS 30 Carter Rd TEL 508-736-8625 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO Q
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER U
BOOSTER I U U
CONVERSION BURNER U U
COOK STOVE 1 � 1 I
DIRECT VENT HEATER I U !1 I I
DRYER l l
FIREPLACE 1 i
FRYOLATOR 11 U ( . I i
FURNACE I I U 1 1 I I
GENERATOR
0 I i
GRILLE J U U I
INFRARED HEATER
LABORATORY COCKS !
MAKEUP AIR UNIT I U I If I OVEN I U U 1
POOL HEATER I Q I I I
ROOM/SPACE HEATER I U U 1 II
ROOF TOP UNIT I 1
TEST
UNIT HEATER I U U U I
UNVENTED ROOM HEATERIs
WATER HEATER 1 I
OTHER
L
II INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO Li
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 st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance_ i all Pertine(it brovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C ../-.--__
PLUMBER-GASFITTER NAME James Carabitses LICENSE# 11156 I SIGNATURE
MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 3759 I PARTNERSHIP❑# LLC❑#
COMPANY NAME: ARS Boston ADDRESS 300 Manley Street
CITY W.Bridgewater I STATE MA ZIP 02379 TEL 508-588-9025
FAX 508-588-1059 CELL EMAIL
H
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
1
PLAN REVIEW NOTES Orr ‘- 2 ,4
7//(V) -
I
/0Z -2 oouchteilif dipseri
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
1® p
1.yisip " CITY YARMOUTH MA DATE 04/12/19 PERMIT# dP"/I-0 S- 1
JOBSITE ADDRESS 30 Carter Rd OWNER'S NAME MACKAY
P OWNER ADDRESS 30 Carter Rd TEL 508-736-8625 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:® RENOVATION:® REPLACEMENT:0 PLANS SUBMITTED: YES El NOD
FIXTURES 7 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 1 11 1 1 1
CROSS CONNECTION DEVICE iI I 1 i
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM 1 . 11
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM q
DEDICATED WATER RECYCLE SYSTEM ' ''' : �,. " 1 i
DISHWASHER I
DRINKING FOUNTAIN i..
FOOD DISPOSER
FLOOR/AREA DRAIN 1 1 1 I
INTERCEPTOR(INTERIOR) I 1 1
KITCHEN SINK I f f
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK I1 lI
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES I 1
WATER PIPING i.
OTHER 1
1
1 I 1
1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY D 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 ❑
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 pest of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia ice with)all Pertin tprovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (, __77a_ __ (,./-.---
PLUMBER'S NAME JAMES CARABITSES LICENSE# 11156 SIGNATURE
MPD JP❑ - CORPORATIOND# 3759 PARTNERSHIP❑# LLC❑#
COMPANY NAME ARS BOSTON ADDRESS 300 MANLEY STREET
CITY WEST BRIDGEWATER STATE MA I ZIP 02379 TEL 508-588-9025 FAX 508-558-1059 CELL EMAIL I
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT# 2C7-1PM—(---. 116
PLAN REVIEW NOTES
Ok 1;(