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HomeMy WebLinkAboutBldp-21-006173 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t---k , c� CITY YARMOUTH MA DATE 4/26/21 PERMIT# BLDP-21-006173 Ili- JOBSITE ADDRESS 109B RIVER ST OWNER'S NAME MOSCA STEPHEN A P OWNER ADDRESS MOSCA CHRISTINE C 54 OLD MIDDLESEX RD BELMONT,MA 02478-3457 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:0 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/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 1 1 ROOF DRAIN SHOWER STALL 3 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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 m NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Keith Parisee LICENSE NA SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 1745 BLOSSOM RD CITY WESTPORT STATE MA ZIP 02790 TEL 7746447499 FAX CELL EMAIL s • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�' ` CITY YARMOUTH MA DATE December 07,202( PERMIT# BLDG-21-003222 e 1 JOBSITE ADDRESS 1098 RIVER ST OWNERS NAME MOSCA STEPHEN A G OWNER ADDRESS MOSCA CHRISTINE C 54 OLD MIDDLESEX RD BELMONT MA 02478-3457 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El 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 1 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 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 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-GASFITTER NAME Keith Parisee LICENSE# PI-32805 SIGNATURE MP❑ MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0#I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 11745 blossom Rd, CITY Westport STATE MA ZIP 102790 I TEL 7746447499 FAX CELL 1 1 EMAIL 1 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •-�'_-S CITY S• /I31 et-4. MA DATE Z — c— Zar Za PERMIT# 1. /71-6V g,3g' JOBSITE ADDRESS /Of 6 Qiuer S,I OWNER'S NAME S44, n P ``�� ,/ ®Zy'� S6 2af7 OWNER ADDRESS SV 6Y1 ,,,,,Gd�.re, ri iho.,,,144.TEL��3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL UV- PRINT CLEARLY NEW:❑ RENOVATION: LIB"/REPLACEMENT:❑ PLANS SUBMITTED: YES[']ENO❑ FIXTURES T FLOOR—F BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ C CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER J' ' DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY t I I . ROOF DRAIN _ SHOWER STALL SERVICE/MOP SINK I rI TOILET I I URINAL 1 ice tft 2321; 1 e WASHING MACHINE CONNECTION 1a WATER HEATER ALL TYPES .._ _ _ _.y,�s _. �1 WATER PIPING I �3UILUING IJEPAR T s_ I a, OTHER T INSURANCE COVERAGE: ,� � I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L' NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY V. 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT i 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 complia ce with all all Pt provision of the Massachusetts State Plg bing C e and Chapter 142 of the General Laws. PLUMBERS NAME Q( Petr(Se__ LICENSE#®t 30,14S-3- SIGNATURE MP❑ JP Ind" CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ADDRESS 17 'S ,S3 'i 0 CITY l` eS77Gr STATE !Z - ZIP LYE 79a TEL ?77'6 'K7 ' FAX ,I CELL EMAIL /Zi f y c/'l`h/ ez-4 6)c "f l r cc„,-,.. hoed 00— ROUGH PLUIVIBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No g0))- )4 t � �` THIS APPLICATION SERVES AS THE PERMIT Ell0k ❑ .16 O"i° J.f)/* 06/4ZO FEE: $ PERMIT# PLAN REVIEW NOTES • J MASSACHUSETTS UNIFORM APPLICATION FOR A PERIUtFT TO PERFORM GAS FITTING WORK 4K' , 0' CITY -5: Yar10041-4_ MA DATE Z J— �� PERMIT# b ✓�-/I- ` l r( 4 QQ ��,,��jj �� JOBSITE ADDRESS 1� B (t"/ R OWNER'S NAME *kr //c<- Az. GOWNER ADDRESS.S.YOfi �"rfldtt c �41 ri5 / ZY fS73c6 aS7 FAX TYPE OFF OCCUPANCY TYPE COMMERCIALEDUCATIONAL PRINT ❑ ❑ RESIDEIJTIAL� CLEARLY NEW:❑ RENOVATION: V REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 APPLIANCES 1 FLOORS-• BSM 1 2 3 4 5 6 7 0 9 10 11 12 I 13 Fir BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE / _1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN -- POOL HEATER • n ROOM I SPACE HEATER r-- 1 1. ROOF TOP UNIT - TEST _.. ;1 . UNIT HEATER ' INVENTED ROOM HEATER B U i WATER HEATER f' ny_ �.-- . - OTHER . - I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E1.10 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY Lg' 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: OVU IER ❑ AGENT El . ' 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 compl' ce with all P ' ent provision of the '' Massachusetts State Plumbing Code and Cha er 142 of the General Laws. PLUMBER-GASFITTER NAME lv(e(''' Petri LICENSE �.,� #iL3Z9OS--5 SIGNATURE MP ❑ MGF 0 JP L1" JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP 0# - 'LLC 0 it COMPANY NAME ADDRESS f 77 n4-' a'- /4 CITY eIJP�S' Ar1.- STATE:M T ZIP TEL 777 65/(K7y?f FAX UUU CELL EMAIL 14,(64141ec/P".4//e-er".q LRki L W.- ROUGH GAS INSP ON NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# • PLAN REVIEW NOTES i