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HomeMy WebLinkAboutBLDP-20-001477 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I-52J CITY YARMOUTH MA DATE 9/16/19 PERMIT#O®ge--Ct9!Y77 1200 ROUTE 28 LAMONICA JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TEL 508 619 3367 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑■ EDUCATIONAL El RESIDENTIAL❑ PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑■ PLANS SUBMITTED: YES❑ NO FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 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 ALL TYPES 1 WATER PIPING OTHER 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 ■❑ 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 El 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 accur the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be• o pliance with P " f provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME DOUG LANGTRY LICENSE# 11305 1 IG ATURE MP❑■ JP❑ CORPORATION El# PARTNERSHIP El# LLCM# 3081 COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28 CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367 FAX 774-470-1350 CELL EMAIL DOUG-AQUA©COMCAST.NET U`h1 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 ?/ /n ry Presscision PPT Test Report Test Status: PASS Test Date/time: 2019/09/17 09:06 AM Test Personnel & Company: Doug Clingan Aqua Services Test Location: 1200 Route 28 • South Yarmouth, MA 02664 Test Notes: Test Type: Fuel Gas Test Media: Gas Test Duration (hr:min): 00:10 Pressure data (psig): Note:negative is pressure drop Start: 9.1 End: 9.1 Change: 0.0 Temperature data (deg F): Note:negative is temp. drop Start: 66.4 End: 65.6 Change: -0.8 Record $: 6 Test Instrument Details Presscision Instrument Model 1 : ppt01 Base SN: 80011729001002 Pod Model 1 : ppt01-pod-pt015g Pod SN: P0011729050001 Cal date: 2019/05/09 Software Version: 1.4.01