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HomeMy WebLinkAboutBldp-19-001214 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ":‘1:01L.W j. CITY Yarmouth MA DATE 8/21/2018 PERMIT# L / —O /'y JOBSITE ADDRESS 27 Wildflower Ln OWNER'S NAME Sharon Donegan GOWNER ADDRESS Sharon Donegan TEL 508-362-6365 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCESj1 FLOORS-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER • BOOSTER • _;. � ,r._ � . CONVERSION BURNER w COOK STOVE ._ �. . DIRECT VENT HEATER _a DRYER FIREPLACE FRYOLATOR i u 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 OTHER �. r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES f NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 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 Michael Maille LICENSE# 11355 SIGNATURE MP MGF JP JGF LPG! CORPORATION # PARTNERSHIP # LLC # 3609 COMPANY NAME: Homeserve USA Energy Services NE LLC ADDRESS 5 Constitution Way CITY Woburn STATE MA ZIP 01801 TEL 781-359-2620 FAX CELL EMAIL rachel.whittick@homeserveusa.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/28/18 PERMIT# BLDP-19-001214 JOBSITE ADDRESS 27 WILDFLOWER VILLAGE OWNER'S NAME DONEGAN SHARON K(LIFE P OWNER ADDRESS 27 WILDFLOWER YARMOUTH PORT, MA 02675-1474 ESl) TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL m PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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 1 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 Michael Maille LICENSE*1355 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Michael J Maille ADDRESS 48 Shore Dr CITY Dracut STATE MA ZIP 018262030 TEL FAX CELL EMAIL I r H PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES j Yes No \C1 "'\ THIS APPLICATION SERVE AS THE ocou�T 0 0 w Q FEES$ PERMIT# �— PLAN REVIEW NOTES I ,ol ;T MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Jr:. -_ u i i4 CITY EYarmouth_� _ 1 MA DATE 8/21/2018 PERMIT#LLD P 9 '6I�/a C JOBSITE ADDRESS j 27 Wildflower V/LifJ6c' —I OWNER'S NAME Sharon Donegan ry POWNER ADDRESS I g _ TEL1 508-362-6365 FAX J TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL j 1 RESIDENTIAL 71 PRINT CLEARLY I NEW:Li RENOVATION:ri REPLACEMENT:[71 PLANS SUBMITTED: YES 0 I NO[' I FIXTURES 1 FLOOR-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB , 1 1 I li i I a CROSS CONNECTION DEVICE ; DEDICATED SPECIAL WASTE SYSTEM i 1 1I 1 ; DEDICATED GAS/OIL/SAND SYSTEM I G II 1 , DEDICATED GREASE 1111111 DEDICATED GRAY WATER TSYSTEM I EM IIIIMIIJIMJIIIIIIIIIIIIIII �' � DEDICATED WATER RECYCLE SYSTEM III 1111111111 _: .. ... , 1 [ i KITCHEN SINK iIIIiiIIIiIIIII LAVATORY1 ROOF DRAIN SHOWER STALL i�!ai�,in� �ni, SERVICE/MOP SINK 1 ! l NIi'; ,I TOILET URINAL "I ( 1._ II WASHING MACHINE CONNECTION mill11111 1111 WATER HEATER ALL TYPES WATER PIPING __ .__,.____ { 1 , , I . .., , I , i OTHERI. I, ,m. ! n11111111 1 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 i i NO [7, 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 Li 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 I'I 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. i /k—w PLUMBER'S NAME?Michael Maille _ _ _ ____ __ J LICENSE# 11355 /X- SIGNATURE MPI-J JP Ili CORPORATION El# —JPARTNERSHIPI I# LLCI I# 3609 COMPANY NAME'Homeserve USA Energy Services NE LLC ADDRESS Constitution Way CITY I Woburn, STATE i ' ZIP 101801 TEL 781-359-2620 FAX _ ._ -__ j CELL L_ ___ —IEMAIL �achel.whittick@homeserveusa.com J ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE: $ PERMIT# PLAN REVIEW NOTES r