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HomeMy WebLinkAboutBldp-22-002170 w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK S. x,=-y CITY YARMOUTH MA DATE 10/18/21 PERMIT# BLDP-22-002170 tr - a. JOBSITE ADDRESS 359 ROUTE 6A OWNER'S NAME Stephen Bordeau .ram P OWNER ADDRESS 359 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS—, FSSM 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❑ 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 Ronald Hague LICENSE t;636 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD J HAGUE ADDRESS 62 NEW BOSTON RD CITY DENNIS STATE MA ZIP 026381901 TEL FAX CELL EMAIL ronhague@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El CI FEES$ PERMIT# PLAN REVIEW NOTES � r 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK >ka.„� ?" BLDG 22 002171 f CITY YARMOUTH MA DATE October 18,2021 PERMIT# r JOBSITE ADDRESS 359 ROUTE 6A OWNER'S NAME Stephen Bordeau G OWNER ADDRESS 359 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 Ronald Hague LICENSE# 7636 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: RONALD J HAGUE ADDRESS. 62 NEW BOSTON RD, CITY DENNIS STATE MA ZIP 026381901 TEL FAX CELL EMAIL ronhaquecomcast.net S310N M3IA321 NVld #11I1\1213d $ :39J 111/1213d 3H1 SV S3AH3S NOLLV3Ildd`d SIHI oN seA S3LON NOI133dSNl lYNId JCINO 3Sfl O103dSNl 210d 30Vd SIHI S310N NOI103dSNI SYJ H9l021 - R MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` fi CITY \Pur VA-4 44 VANPor MA DATE lb 1 1 C) \ PERMIT# Z '21.7/ JOBSITE ADDRESS IC-q "� b OWNER'S NAME S l Ve 4264r &a..\ OWNER ADDRESS TEI6-1) 6' — L 9 3 VAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: [ - PLANS SUBMITTED: YES❑ NO 0 APPLIANCES FLOORS-4 SSlut 1 2 3 4 5 6 7 8 9 10 'I'i 12 •I3 I 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE —� DIRECT VENT HEATER H DRYER, FIREPLACE —� i FRYOLATOR FURNACE ( , GENERATOR GRILLE INFRARED HEATER —7 LABORATORY COCKS • MAKEUP AIR UNIT —1 OVEN POOL HEATER • ROOM I SPACE HEATER R F F l V ff D ROOF TOP UNIT TEST _. UNIT HEATER MT 15 2021 UNVENTED ROOM HEATER I _ WATER HEATER t BI.ILDING-DE RTMENT OTHER By: INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 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 s.., 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. LU PLUMBER-GASFITTER NAME LICENSE#1 L'3 L SIGNATURE MP . MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIPP 0# LLC❑# COMPANY NAME 44f.1 ba � � 3 ADDRESS �"�` b CITY NA0\t s 1 STATEM'4' ZIP o Z L 3 d' TEL FAX CELL 31.4 — 19 ye EMAIL cow har w( 9 co La, v"_f CC4-NSA cp 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 APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY `3 t.,,w K "\.,,J�r`� MA DATE \ t) I t Z► PERMIT# 2 2- 2 ID O JOBSITE ADDRESS 41SI \ &D OWNERS NAME61�t/ t301-t-r��°�K OWNER ADDRESS cS\t‘ 0 TEL(ov)iik;.4 -613 I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:PI` PLANS SUBMI I I ED: YES❑ NO FIXTURES 7 FLOOR-4 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM T—� 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 R E E URINAL . WASHING MACHINE CONNECTION t i WATER HEATER ALL TYPES ( ACT 15 Z021 _ WATER PIPING _ OTHER BVILDING•D-0'A 2TME'T • B_v INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Eci NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pliance wyth all rtin ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# -7 63 GNAT' MP[- JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME k-k-ck5 LA..( P r, \-A ADDRESS ���`J a c)S CITY 6.te nA S STATE 'n'` ZIP dab 3 F TEL FAX CELL (S-0 ZJ 3 6 1 `R((((6 EMAIL CO S _ T.4 �'