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HomeMy WebLinkAboutBLDP-22-000851 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK cr CITY YARMOUTH MA DATE 8/16/21 PERMIT# BLDP-22-000851 JOBSITE ADDRESS 86 WIMBLEDON DR OWNER'S NAME MORAN ELAINE P OWNER ADDRESS 4 WHIFFLETREE RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑ FIXTURES • 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0 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 Mcbride LICENSE t9681 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES S PERMIT# PLAN REVIEW NOTES • MASSAC USETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CIN , MAIM - 1 :?' MA DATE ZPERMIT# 27- ^2 r( JOBSITE ADDRESS I( 4.),0Yi p de-214 Oriv4 OWNERS NAME17 OWNER ADDRESS r PP( ± M Z%L `7 ?Pt FAX r P rifri of TYPE OR OCCUPANCY TYPE COMM CIAL 0 'UCATIONAL ❑ RESIDENTIAL a, PRINT CLEARLY NEW 0. RENOVATION:0 REPLACEMENT:g . PLANS SUBMITTED: YES 0 N9 FIXTURES Z FLOOR-► BSM 1 1 2 3 4 5 1 6 1 X 8 1 9 10 11 12 j 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f DEDICATED WATER RECYCLE SYSTEM J DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN r INTERCEPTOR(INTERIOR) �--� KITCHEN SINK C �r1 - j LAVATORY • ROOF DRAIN - _ SHOWER STALL SERVICE/MOP SINK TOILET Bust nirvc- - - URINAL I 13y 1.1 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / WATER PIPING OTHER i • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142.. YES IX NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Xi OTHER TYPE OF INDEMNITY 0 BOND 0 i 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 apVication waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 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 m and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a Pertinent provision edge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. S., ` of the .!v PLUMBER'S NAME A I cttke ,c..8 f ,I LICENSE#/Va./. L SIGNATURE MP 0 JP 0 CORPORATION 0# PARTNERSHIP❑.# LLC❑# Prop, COMPANY NkMF Al _11° h aid' ADDRESS ? du 51 /c 6 r ,(, CITY G Pin (�(J i+' " f STATE ZIP L)?.Q 73 TEL , 0____/____,2„,_ FAX CELL , , EMAIL 5./iP/`';yl C ccio ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# • PLAN REVIEW NOTES • • . I . i . I f i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r' c CITY YARMOUTH MA DATE August 16,2021 PERMIT# BLDP-22-000851 lr JOBSITE ADDRESS 86 WIMBLEDON DR OWNER'S NAME MORAN ELAINE G OWNER ADDRESS 4 WHIFFLETREE RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS—I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR 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 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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. 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 Mcbride LICENSE# 19681 I SIGNATURE MP 0 MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: (MICHAEL R MCBRIDE I ADDRESS. 19 Rustic Drive, CITY (West Yarmouth 'STATE IMA I ZIP 102673 I TEL 1 FAX 1 1 CELL 1 1 EMAIL Istinger.mcbride(a amail.com S310N MIA NVld #111%13d $:33d ❑ 0 IJ11a3d 3H1SV S3AH3S NOIlVOIlddV SIHl oN seA S310N NOI103dSNI IVNId NINO 3Sf1210103dSNI 210d 3OVd SIHI S310N NOI103dSNI SV)HOf O I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO PERFORM GAS FITTING WORK .7 CITY CA—,--\1� f M D V t---11MADA I Zl PERMIT# ZZ S'2C JOBSITE ADDRESS '.S CD Z Il_( At bL. OWNER'S NAME -C9C 'S U U l UR/9 GOWNER ADDRESS bk—,4( P- -e 7 /44.- 7- it ,77- �l f ZFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS-4 9SM 1 2 3 _ 4 5 6 7 8 9 10 11 12 1;----T _ 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE . DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE - P1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN ,ray 13 021 POOL HEATER . ROOM/SPACE HEATER --- ROOF TOP UNIT Buba niNio 1)1--HtiRTIMPNT TEST _.. ... ... . .__. . . . . . . ._ ....__.._.._ .. . ......._ .._ UNIT HEATER INVENTED ROOM HEATER - WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El 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. L A � � PLUMBER-GASFITTER NAMEPO- L(J J Cst t.��&eL LICENSE# SIGNATURE UR MP❑ MGF❑ JP j;;1 JGF❑ LPG'❑ CORPORATION El# PARTNERSHIP 1:1# LC ED# COMPANY NAME C 1(7--ta t T ADDRESS vvv/ 5r7 C 4 r( (le CITY `--^1 >----{G\ Cik40 U ' "l STATE 1/141V—` ZIP 0 2 ! 3 TEL ?7 r7 d Y/�z FAX CELL EMAIL'S —uA f/`-44 9-P @))A"414- `c-lis-\. 4 ROUGH GAS INSPECTION NOTES IBIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES