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HomeMy WebLinkAboutBldp-21-006959 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ck,,,,,, , et CITY YARMOUTH MA DATE 6/1/21 PERMIT# BLDP-21-006959 I' ' JOBSITE ADDRESS 18 RAINBOW RD OWNER'S NAME frank verges P OWNER ADDRESS 18 RAINBOW RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING 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 El 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❑ 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. PLUMBERS NAME Steven Austin LICENSE 28008 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEVEN M AUSTIN ADDRESS 26 STATE ST APT B-10 CITY ATTLEBORO STATE MA ZIP 027032061 TEL FAX CELL EMAIL saust.75@gmail.com r • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES E PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ViCITY YARMOUTH MA DATE June 01,2021 PERMIT# BLDG-21-006957 JOBSITE ADDRESS 18 RAINBOW RD OWNER'S NAME frank vargas G OWNER ADDRESS 18 RAINBOW RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 1 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ 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-GASFITTER NAME Steven Austin LICENSE# 33008 SIGNATURE MP❑ MGF 0 JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: 'STEVEN M AUSTIN I ADDRESS. 26 STATE ST,APT B-10 CITY IATTLEBORO STATE MA ZIP 027032061 TEL I FAX I CELL I EMAIL Isaust.75@gmail.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 ==_ram=: -'�= CITY YM 6 LATP.- MA-, MA DATE 6 '-/ tea/ PERMIT#L�LDP-1i-00 (o`is`'1 JOBSITE ADDRESS it RAIlAi J0 r,J lea/ OWNER'S NAME 4,4 vfr s POWNER ADDRESS 41 TE6O4 3 Y t/&)AX _ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATIONX REPLACEMENT:D PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR—F 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 SYSTEM DISHWASHER I • DRINKING FOUNTAIN FOOD DISPOSER t ' ;7 e e , 1 , FLOOR/AREA DRAIN _ F •, al: INTERCEPTOR(INTERIOR) 1 i KITCHEN SINK 1 ' _ , ' ` LAVATORY r i ROOF DRAIN �' SHOWER STALL lk `� ���r SERVICE/MOP SINK TOILET _ _ URINAL WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES WATER PIPING I OTHER 1 H INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES)/ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY g 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 1 Massac set General Laws,and signature on this permit application waives this requirement. • '" CHECK ONE ONLY: OWNER 0 AGENT pi ' SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are e 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 p' nce with all rtinent pn of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME LICENSE# 3 3 e• / SI NATURE MP❑ JP CORPORATION 0# PARTNERSHIP❑.# LLC Ell# COMPANY NAME SIMI& Aiiikrej AJ ADDRESS I a 0 emir CITY A). A111441.10 STATE M ZIP 0 * 1 C•0 TEL FAX '""'"" CELL S`AA.. EMAIL SkwST. Ire G . 14 1 LID 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 ' '` . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I PMtre," CITY L j%;,- '-10/ 1 t.,. MITE t b- ` % PERMIT 0(O-Li- 00(041 � r'r JOBSITE ADDRESS I /C,a! kJ) )..•;;s JQ... j OWNERS NAME '/tir-•i/ fete ,A.-5, G _... OWNER ADDRESS /1-7 "`.,, k VA,*a l'S TEL 1M) 3 iic A/R .ki, `., TYPE OR APE OCCUPANCYRINT TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL K 1 APPLIANCES-1 FLOORS--I BSM 1 2 3 4 5 6 7 8 9 10 111 12 13 14 f BOILER —� BOOSTER CONVERSION BURNER COOK STOVE \/ ----; DIRECT VENT HEATER -I DRYER FIREPLACE • € FRYOLATOR - FURNACE GENERATOR GRILLE INFRARED HEATER _______I LABORATORY COCKS MAKEUP AIR UNIT ,7 , - r — OVEN ri i POOL HEATER ROOM l SPACE HEATER ' ROOF TOP UNIT 1 t TEST UNIT HEATER P, _ UNVENTED 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 4 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I! OTHER TYPE INDEMNITY ❑ BOND ❑ OWNE 'S INSURANCE WAIVER: I ant aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass rlipus_etts General Laws,lid that my signature on this permit application waives this requirement. , p..4.,..-- 14,"2,45*.::..... CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT zi, 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 y knowledge ``— and that all plumbing work and installations performed under the permit issued for this application will be in coma ti ce with all Pe inent provi ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.LE j 1�\ I PLUMBER-GASFITTER NAME LICENSE# ..-1:3 co `/ •� SIGNATURE MP E MGF❑ JP JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC❑ COMPANY NAME C`. •4'-E0^P. y�' ^ t? CITY / l i % /7/: :.)~LD iA/A- ZIP 7,CJ 5-' I STATE ✓ n TEL .� . � ^ ��,%,•'��u.� FAX CELL 1'f ?/2-2c 65 EMAIL /41,- 1', 7 /!�1 ,. } ------------— -----------— --- ---- - ----. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR j USE ONLY FINALISPEC$! NOTES Yes A ) THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ / • § . « FEE: $ PERMIT I PLAN REVIEW \NOTES \ \ . ) • ' } ) / • \ . ) } ! / _ • ) �-