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Home My WebLink AboutBLDP-23-004736 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �� CITY YARMOUTH/1/4,,,„ MA DATE February 27,2023 PERMIT# BLDP-23-004736 JOBSITE ADDRESS /31 /4-4- zy C 4PE S'¢"'af OWNERS NAME G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ID RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 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 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❑ 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 david koss LICENSE# 10377 SIGNATURE MP© MGF ❑ JP El JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: IDAVID KOSS ADDRESS. 136 WASHINGTON AV, CITY IWEST YARMOUTH STATE MA ZIP 026732434 TEL I FAX I CELL 5083674424 EMAIL DAVIDan,KOSSPLUMBING.COM -'` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4., Sr 0IKwldV11• MA DATE 2 ZY T�Z3 r-.• _ _� / PERMIT,r 23 `-j? '3L 1 E DDRESS G '1't� /� �l T L f'� , j F vWNER S NAME 4 4 021.9M:R ,'DRESS TEL Fey a PA' - PrAI CY TYPE COMMERCIAL r-,' EDUCATIONAL DUCATIONAL ❑ RESIDENTIAL El -111'l 'Mil NE Y: il RENOVATION: 0 REPLACEMENT:Lam' PLANS SUBMITTED: YES 0 NO[/ APPLIANCES 1 FLOORS-+ BOILER WM.= 5 6 9 10 11 BOOSTER ® 13 il � � =� CONVERSION BURNEP, --�� COOK STOVE _�-- r-- DIRECTVENT HEATER �- -- MINIM DIRECT FIREPLACE FRYOLATOR al - MI GENERATOR _�-- GRILLE MI-�-_ -FURNACE 111111 MI INFRARED HEATER �_- LABOP,ATORY COCKS MN _ _ MAKEUP AIR UNIT -- OVPOEN Mil--�_ POOL HEATER • w- Minillin _ ROOM I SPACE HEATER ROOF TOP UNIT TEST ... UNIT HEATER - UNVENTED ROOM HEATER Milli . -wATER HEATER __� OTHER _�� _— MIME 1 INSURANCE COVERAGE —all= I have a current ligt_ALN.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 0 LIABILITY INSURANCE POLICY kl,Z 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. • I SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT ❑ hereby certify that all of the details and information I have submitted or entered regarding this application a and acc to to the best of m and that all plumbing work and installations performed under the permit issued for this application will be in c mplia awl II ne y knowledge Li t Massachusetts State Plumbing Code and Chapter 142 of the General Laws, vision of the PLUMBER-GASFITTER NAME LICENSE# f MP It/MGF El JP 0 JGF El LPG! ElCORPORATION / 3 7 SIGNATURE ,/ �� ❑# PARTNERSHIP El LLC 0# COMPANY NAME / OSS f�l.1/l4✓I C/ G ADDRESS 6 4-1/4 04' tb iv `/ CITY S r Y44 Pttli 01/'rW STATE MO- ZIP 0 ZG 13 TEL FAX - / CELL , '�Y L 2- �f`�Z'IEMAIL L�1 . JJ /°G V rM,1 4).=f B- 2 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH 11/4 MA DATE 2/27/23 PERMIT# BLDP-23-004736 tI JOBSITE ADDRESS i 3 4 /?w,t. Z} �'/�/'G s vl OWNER'S NAME P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0 PRINT CI CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES NO FIXTURES 1 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 _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 El 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❑ 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'S NAME Idavid koss LICENS410377 I SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# I I COMPANY NAME IDAVID KOSS I ADDRESS 136 WASHINGTON AV I CITY IWEST YARMOUTH I STATE IMA I ZIP 1026732434 I TEL I I FAX I I CELL 15083674424 I EMAIL IDAVID@KOSSPLUMBING.COM 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I_ _�A=• � « 7- v efv O(/ll't MA DATE 2Aq/012-3 PERMIT# 'z--N- 4-( 1 3C a: 11_t .S /119 /14 N s---/T"-"OWNER'S NAME • EBB tic 449123 ADa•c S TEL FAX au 4:- 'ONk of F Cj1 P k Y PE COMMERCIAL Q' EDUCATIONAL 0 RESIDENTIAL❑ PRI FNr. ^� CLEARLY N `• a RENOVATION:❑ REPLACEMENT:�J' PLANS SUBMITTED: YES 0 NO E(/- FIXTURES 1. FLOOR-* BSM 1 2 3 4 5 6 7 6• 9 10 11 12 J 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM -- DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM . DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN - tINTERCEPTOR(INTERIOR) _ KITCHEN SINK I LAVATORY • J; ROOF DRAIN \;f SHOWER STALL .I SERVICE/MOP SINK I TOILET j URINAL ..11 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I _1Q I WATER PIPING b.I OTHER �i INSURANCE COVERAGE: 1 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er 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 il Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT Lk.1 I hereby certify that all of the details and information I have submitted or entered regarding this application a and accu to best of m knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn an wi II P pr the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 6 4"I/ / 4 Jr1`ct s S LICENSE# I 0 3 7.? SIGNATURE MP El JP 0 CORPORATION❑# PARTNERSHIP❑.# LLC 0# COMPANY NAME /4 S S P �'l'i ADDRESS 3b tv,qf (J 6 fa 4(7 CITY (Jt S T VA 4,-/d U 11 ' STATE I44A ZIP 0 Z 6 73 TEL FAX CELL 50e'36 7 q%' 1'EMAIL C/9 V/G 0 J o3 J rLv,,,,6, y✓C• ,•O, .