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HomeMy WebLinkAboutBldp-22-002083 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' • q & CITY YARMOUTH MA DATE 10/12/21 PERMIT# BLDP-22-002083 JOBSITE ADDRESS 27 MCGEE ST OWNERS NAME Pam Perry P OWNER ADDRESS 27 MCGEE ST WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 1 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/OIUSAND 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❑ 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. 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 Gray LICENS412426 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL J GRAY ADDRESS 12 BEACON ST CITY BEDFORD STATE MA ZIP 017302403 TEL FAX CELL EMAIL grayboysplumbing@verizon.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES r r 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 12,2021 PERMIT# BLDP-22-002083 t; JOBSITE ADDRESS 27 MCGEE ST OWNER'S NAME Pam Perry G OWNER ADDRESS 27 MCGEE ST WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL al PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS—> 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER - c 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 Gray LICENSE# 12426 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL J GRAY ADDRESS. 12 BEACON ST, CITY BEDFORD STATE MA ZIP 017302403 TEL FAX CELL EMAIL grayboysplumbing anverizon.net S310N M2IAM:1 NVld #IIM3d $ :333 El El 11W213d 3H1 SV S3A213S NOI1VOIlddV SIHI oN seA S310N N0I103dSNI 1VNEI K1N0 3Sfl I10103dSNi 210d 39Vd SIHL S310N N01103dSNI SVS HJfOI MA88ACHUSETTB UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: W es1 )/ ( wf(4 MA DATE: /a/5/ / PERMIT II G JoBSIrE cp1 Me (ae2 5 f OWNERS NAkE: )4/7 y OWNER ADDRESS; TEL: Sit-51g►`al36,FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL La PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[ PLANS SUBMIrIED: YES❑ NO❑ APPLUWCE81 FLOOR-, Sari 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOLER BOOSTER CONVERSION BURNER COOK STOVE DETECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRLLE INFRARED HEATER w LABORATORY COCK _ . MAKEUP AIR UNIT 4 OVEN . POOL HEATER ROOM I SPACE HEATER -J ROOF TOP UNIT TEST • UNIT HEATER -4 uj UNVENTED ROOM HEATER _ WATER HEATER INSURANCE COVERAGE I have a current Gouty insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO ❑ ifyou have checked yam,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND 0 O MER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapbx 142 of the Massachusetts General Laws,and that my signature on this permit application wan this requirement. CHECK ONE ONLY: OWNER ❑ AGENT❑ SIGNATURE OF OWNER OR AGENT hereby caddy that all of the details and khtonnalion I have submitted(or entered)regarring this application are true and accurate to the best of my Knowledge and that all plumbing work and k riots performed under the pemdt issued for hues application MI be Pertinent of the State Plun bing Code and Chapter 142 cite General Laws. Wilft.414C/19,0 /PLUSNAME r "J1C u \ l"J11� LICENSE# [?Np COMPANY NAME: &ray LAM' h I ADDRESS: 2,i I'J.C►Stwe` CITY: )�,ltv►(e/l STATE:MA MP: i)J4'LP FAx Aire 3 33 I TEL: l l A33 CELL:70- 591. 3/o.7 EMAIL: a ral Glii y ve✓17.1M_. yl, MASTER JOURNEYMAN❑ LP INSTALLER D CORPORATION❑# PARTNERSHIP❑# LLC 0# E`ri c, 091)Theoss R