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HomeMy WebLinkAboutBldp-22-001509 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _, CITY YARMOUTH MA DATE 9/16/21 PERMIT# BLDP-22-001509 ti JOBSITE ADDRESS 66 SWIFT BROOK RD OWNER'S NAME Andrew Either P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 1 FLOORS--I 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❑ 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 Thomas Coughlan LICENSE S629 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THOMAS J COUGHLAN ADDRESS 48 HERITAGE DR CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El FEES S PERMIT# PLAN REVIEW NOTES c MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 16,202 PERMIT# BLDG 22 001510 littuz JOBSITE ADDRESS 66 SWIFT BROOK RD OWNERS NAME Andrew Either G OWNER ADDRESS TEL_ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 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 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 Thomas Coughlan LICENSE# 8529 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑#l LLC ❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL 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 r 1 1 � I +y______ Y , „�{ S 4 HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �f�(t m� t ,_....—.__1 MA DATE �'- ,c-a- 1 I PERMIT# ,-i - I I b CITY 22 2'( • JOB�SITE AID SS (Q G t -. e..Cu C. j .,OWNER'S NAME 1 N aQ&Q C e�2_. I B Li i 'dam L' 00bikt' R SS .7 S�Z t'ri r�... ..�,_,�,.�._ - - iv LTEL FAX`__ f Jt'YP OR OCCUPANCY TYPE COMMERCIAL.j_ EDUCATIONAL J RESIDENTIAL( PRINT CLEARLY NEW:J RENOVATION:'_.-I REPLACEMENT:V.r PLANS SUBMITTED: YES,J. NO APPLIANCES'1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER —J___I_1___I—J.__J_._!—_I—J J__I___J. I_J_—I BOOSTER I I I: I Tt _ 1_ j_I ._-1—J— . . . 1—J CONVERSION BURNER I.__ I I I f; I __I_J j_ :__I: -___I COOK STOVE I I I, __I_-1`I I_1_1—J__I_I_!_!_1 DIRECT VENT HEATER _ . ,_J J ___1 1 _I_____.1 DRYER. i I—J_I___ 1� i,—J I 1 1 I_- f FIREPLACE 1 1_._ 1 -1.—.!_.J_J .. _ _I . I _1 1 ___ 1 I _. 1_J JFRYOLATOR - '_-_:.-1—_I___1. I .... I. I 1 _._1 _______I _1_I—1 FURNACE __1 I __ I I__I_I ! I .r_1__J _._.._1.__—I_ I 1 GENERATOR 1.. .. . I:... 1 1 GRILLE i_._J: I__I___J .._._1___J__J'__!-___.._ I___J_1_____I__,__J___J INFRARED HEATER ( !—J _-1 1 _1 -._. I__I i—J _�—J _-1__J 1 LABORATORY COCKS I - 1 . I ._wi_I I_I _.._._J_._._.._I I,__1_1 1_.1 itMAKEUP AIR UNIT , !: i__J_ ____J___J__J I I ^I. I_ _j._J OVEN ---I I 1 I 1_r l .! I _1 1 _..._._1—i_ 1__J I 4. POOL HEATER _J I_.._.,_J '.____I --__ - I ! I— e__ -I J_._.._ __1 I� —__.I_I 1 ROOM/SPACE HEATER __1 1____I 1 --i_ I_ 1 1 i + f I_ J_ I ROOF TOP UNIT I I ' 1____II I I_J 1_ _I_I TEST I __--I I__ _,..I_.�i 1- 1 i_ I I UNIT HEATER _ __. _ _._.__a. UNVENTED ROOM HEATER 1 1, ! i ! 1______I I_I__I_I`_J i__J WATER HEATER I I , 1— i 1_ ... j r_______I I _I OTHER. I I___J i I,W._ 1 i--I ! I__ �_J_J 1 _. �I —I . . I I: 1 I_I I i 1_I _ I ._____J_!_1 1 I_J 1 1 1 -_,:___1........1 1_ _____I __ 1 I_.�..1_I= I I i _.1_1 __.1 I I i I I_.._J 1 __-_-J I I . -_I - I I -.. -. 1 INSURANCE COVERAGE tI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES(NO 'J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE INDEMNITY BOND U 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 '_I AGENT _I 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 provi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / /� PLUMBER-GASFITTER NAME ffam/4 S Qpu O-#L ( LICENSE# kag L- f�SIGNA E MP'(MGF' 1 JP GF_� LPGI_J CORPORATION ]— •- -.-_ r_.._. s f�j�'7L' PARTNERSHIP..—�,# I LLC:�_#` COMPANY NAME i4t"L Ne)1T1A9.- COO( / UG-,f ADDRESS 3o 9 Zicc f— TjItt d� —. . --_- CITY _ 1t-/,vt ou lr-- ,/N t 73 7.. 4O J _ -- . - __-- 1 STATE �. ZIP O�7�.- TEL ,5 D��- - FAX�-' j CELL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: S PERMIT# PLAN REVIEW NOTES a lnAP: efig e C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 '' 1 ilii I E tkri, yo LMUt.I.T , 1 MA .DATE 91l D-( 1 PERMIT# al- lc 01 1 1 Q TE 4DF ESS 6 ,cE3e ' B too le- RO• I OWNER'S NAME AN h Q� 5l rI e� I P OW[[�UN�1EllRA DRESS I 5w Fr d TEL IFAX BUiLDIN(.3 D PAR I MLNT [TYPE OR_ OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL war-- PLANS SUBMITTED: YES 0 NO� CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: FIXTURES 1 FLOOR--' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 f BATHTUB I ' _� - CROSS CONNECTION DEVICE - �.- DEDICATED SPECIAL WASTE SYSTEM I. .� .y I �� -' -L 1. _ � �__ J_ _ -I` -A t DEDICATED GAS/OIUSAND SYSTEM 1 -., i_L._ I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM yl _.,. 1 it _. i i_ _ ._ , DEDICATED WATER RECYCLE SYSTEM " 1_ ,..w, I.,_ L y DISHWASHER - .�. DRINKING FOUNTAIN ,I L I . ,_ _ �' L...." �—, , ,._ I FOOD DISPOSER . _ "J I w- FLOOR/AREA DRAINlilli ' '^ !I �i " INTERCEPTOR INTERIOR111.111111011111111110 , I , KITCHEN SINK LAVATORY i I L_ T 1 ! L-- ' 1 ROOF DRAIN - __ J SHOWER STALL I I�_ �_ a I SERVICE!MOP SINK it �..••, fi - / TOILET ,_ -� _ �, .- - I i II I,� URINAL _ ._a _. _ . t � L r i �i , r � jj WASHING MACHINE CONNECTION I _ 1 I. ' . I ._.,..,'I i _ . ._ �i . ' sit ,WATER HEATER ALL TYPES � I � - � �I � :WATERPIPING I -OTHER � --�„�.�•--� -_ , � -fD n 1 1:i_ i.- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 4( NO , 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. 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 1 ton?Ac C'.nLICeME-C�a A) L LICENSE# 85a?-MI SIGNA RE MPS.-- JP" CORPORATION# qi5 K 7 !PARTNERSHIPO#, LLCO# COMPANY NAME 491-G f(£)f71A1G-1.-Coo:.INS ADDRESS 30 1196l./ 4 `DLL vE- CITY Yna.MOu're-- ISTATE ZIP Oa6 --)3— { TEL .$ )2-73?�cUt FAX I CELL EMAIL -WI M 14 y C. c/R 6 m/PL.%ro 1 -Rl43 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES • La.