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HomeMy WebLinkAboutBld-22-002675 N. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK , :_ CITY YARMOUTH MA DATE 11/9/21 PERMIT# BLDP-22-002675 i'` JOBSITE ADDRESS 570 WEST YARMOUTH RD OWNER'S NAME BEDFORD WARREN P OWNER ADDRESS TUOHY-BEDFORD MAUREEN 570 W YARMOUTH RD WEST YARMOUTH,MA TEL 02673 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL al PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:m PLANS SUBMITTED: YES NO❑ FIXTURES 1 FLOORS—. , RSM 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 El 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❑ 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 Peter Gonyea LICENSE 1 720 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME (PETER R GONYEA ADDRESS 112 MARGARET JOSEPH RD )UTH PORT STATE IMA ZIP 026752440 TEL CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e•- c CITY YARMOUTH MA DATE November 09,2021 PERMIT# BLDP-22-002675 Fir JOBSITE ADDRESS 570 WEST YARMOUTH RD OWNER'S NAME [BEDFORD WARREN G OWNER ADDRESS TUOHY-BEDFORD MAUREEN 570 W YARMOUTH RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 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/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 0 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 Peter Gonyea LICENSE# 15720 SIGNATURE MP 0 MGF 0 JP© JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: PETER R GONYEA ADDRESS. 12 MARGARET JOSEPH RD, CITY YARMOUTH PORT STATE MA ZIP 026752440 TEL FAX CELL EMAIL r S310N M3IA321 NHld #1IW213d $:33d 0 El 1111213d 3H1 Sd S3A213S NOI.VOIlddV SIHI oN seA S310N NOI103dSNI lYNId AlN0 3Sfl NO103dSNI 210d 3OVd SIH1 S310N NOI103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM V �` PLUMBING WORK n— I.— CITY Yarmouth MA DATE 11ThvnAIIIIM PERMIT# ZZ— 2 b 5— JosSfrE ADDRESS impjearsimill9211111 OWNER's NAME romarovzsrimme P OWNER ADDRESS: gr TYPE OR TEL: Soi��p,R66> AX OCCUPANCY TYPE: COMMERCIAL 0EDUCATIONAL CLEARLY RESIDENTIAL� NEW:❑ RENOVATION:❑ REPLACEMENT:®/ FIXUTRES 1 FLOORS—' PLANS SUBMITTED: YES 0 NO❑ IMEau — ���� 6 0 8 9 10 ®® CROSS CONN DEVICE _ ____=________ DEDICATED SPECIAL WASTE SYSDEDICATED GASIONAAND _= __ __ MUM DEDICATED GREASE SYSTEM 111111111111 DEDICATED GRAY WATER SYS ___1111111111111111111111111111111111 _—__ ______ DISHWASHERDEDICATED ATER REUSESY3 =IIIIII _____====___ DRINKING FOUNTAIN _ ===�_____=== FLOOR == __FOOD /ASTE GRINDER UNIT __—==== IIIII VAREA = INTERCEPTOR INTERIOR __ ______ _____ KITCHEN SINK _____� LAVATORY ='�==��_______ ROOF DRAIN ==___=_________ SHOWER STALL __ �■� �_ TOILETSERVICE/MOP SINK ____ �lizxlI�3LTj ��I_ mmon IIIIIIIIIIIIIIIIIIIIII WASHING MACHINE CONNECTION _= 111111111111 =����I�,NM IIIIIIIIIII I ��a�r11_____��i� have a current I I insuranc I C i ������ e policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 If you have checked YFs please Indicate the type of coveragebychecking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee Massachusetts G- .I Laws,and that my signature on this permit the is coverage u required by Chapter 142 of the G S NATU- OF OWNER AGENT CHECK ONE ONLY: OWNER Er AGENT 0 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 Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In compliance with all Pertinent myprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ertleM , PLUMBER NAME LICENSE IS C5 SIGNATURE COMPANY NAME ADDRESS: Mt .4 _ , , .r _ CITY: s STATE: [J Z1P: b TEL: !� �-- —6�' '� FAX: r CELL: EMAIL: MASTER Q JOURNEYMAN EY CORPORATION 0#E= 1 PARTNERSHIP 0# E:=1!LC❑#� y -Cf.43 14' • LE ti41 INSPEr-rinN NOTE1 [t L' B f LOW FOIE OFFICE.►SE ONLY i.'.. NSPE O Rn [�II( IN PECTION NOTESYei nag 0 eugagN CFRIIES A R • FEE: S Paw ..L.n n arviA W NOTESS • • • • A • aLoP- 12 7-(°-1r MASSACHUSE'TfS UNIFORM APPUCATION FOR PERMIT TO 00 #ASFITTING BILLIPtw1t a ryas rr �� a•� I� � Mass., Cate, d 9 Permit' / * S7t) 1u/' 11 a v2 Owner's Name 1t/L7 ' U Si Budding lOCatlan /� / - / >lAJ'D a�, !">P9 Tyne of Ocuioancy /� 'ff fi 4A. Now O Renovation Q Redacenertt m/ Plans Submitted: YesC No = N s r W r s et .i r• • u S M heS w s • o Is N S d u s = s e ° a fi r s s _ o C W 4 a a 3 o = : - i • W� re A le a l 7< sN 3 y N W N W Z '1 W a N Vi W i W r1 • ' FN N v /' .4s ys ssO .. O ta = _ < W e . i O y C a •s' 00 s W s 3 /4 C Y C sus 43Wr. l I I I I V 11 I I 1 11 I I t!ASXMIXTer I I L I I I I I I I I I J I I I I I I 1 ' ,sT IBLOOR I I I I I I I I I I I I I I I I I I I i I . :NO R(.oan I I I I I I I I I I I I I I I i ' 3A* 011.130A i I l I 11 1 I ! I I I I 1 1 I 1 • ' .TM Rt.aOA I i l I ) ! I I I j I I I I i i I ' STM PLOOX I I I I I I I L l I I I I I I I I I I I `Tr.Pl.aon ( I I I I I I r I < I I I I l l 7Tt4 PLOo11 I I I I i i I I I I I I I 11 IIT11 Rt.00n • j , 1 I I I I I I I Installing Campany Name `da t-1 2 R _11 j� cheek one: Certificate address 1 .97/_,,r -es .4 *1- st�4P , zP Carooration ills�f 'Q ti rr' Partnersrn0 Business TdeOnone 1.0 '7, S 7 C •F,rn/Ca. Nam t of Licensed Plumber or Gas Ftter 7!� .[ I? INSURANCE COVERAGE: have a current liability insurance policy or Rs substantial equivalent wnien meets the requirements of kAG` .~ .. Yes r✓ No r' If you have cheeXed in. Zeno indicate Me type coverage by cnednng the a00reonate box. A liability Insurance policy 74 Other type of indernriity= Bond OWNER'S INSURANCE WAIVER: 1 am awere that the licensee does not have the insurance coverage -ecuired .v cheat 142 of the ass. General Laws. and that my signature on this permit aoclication Naives !his •eouirerert r Check one: ,/ ownerf�-- Agent = ball fir fir s 1 hen y emery that at at the deals and Information I have s lanetted for entered)In active aoodntion are true ana accurate!o the nest :t -v mamma,fine that ail si unou+g wart and installations confirmed under the Oermit Issued for trus aoolicaton wid be In comouance vim au seem tt Dransions at the Mesaacnusettl Slate Gas Code and Claoter 142 at the . ?y_ Tyne of Ucans*: `T�J ...Phonon Signature or Ucensea rlumoer or'tea ter rate '-Gasnitter Master Ucense Murree( I•Nc____Zia , Atv/TaV c� c . -Ar.«rm.yrnei R E e E 1 V E D NOV 08 2021 • BUILDING DEPARTMENT 15 1H i, IT A la_ N x Ic, .T iN I r. • pi 2 t ... ii G 0 0 3w A 2 O 7A 7 2 .4 r 0 '9 A a le - s 0 0 eis 2 0-04 G t, ON s 0 0 A � , _ O a C A • = .' r lA O O • a OO - a a a s r _ • I A y A 7 O I7 7 la iQ 1> up i= f • t