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HomeMy WebLinkAboutBLDP-23-000687 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/10/22 PERMIT# BLDP-23-000687 e i' JOBSITE ADDRESS 280 ROUTE 28 OWNER'S NAME ACME LAUNDRY CO INC P OWNER ADDRESS 124 RIDGEWOOD AVE HYANNIS,MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© 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/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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 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❑ 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 Walter Nye LICENSE 1RL17021-M SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME INye Plumbing&Heating Inc ADDRESS 349 Great Western Rd CITY Harwich STATE MA ZIP 102645 TEL FAX I CELL 15082463349 EMAIL I .N. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 - ;sr" CITY VV/"..>i /Aft it-t�u 71/ MA DATE 1110 bpi :.�',,. I { PERMIT f�G/X9J OOd(Q97 JOBSITE ADDRESS .St-) I`i OWNERS NAME J' R.E Ci-E '") GOWNER ADDRESS 3 ("4"-c w TiLE TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL\ EDUCATIONAL PRINT ❑ RESIDENTIAL❑ CLEARLY NEW;`Q, RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-4 BSM 1 2 3 .1 5 6 7 o 9 10 11 12 •13-1 h BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER —__1__— FIREPLACE i FRYOLATOR ► FURNACE GENERATOR GRILLE I I INFRARED HEATER —_ LABORATORY COCKS —� ___________I MAKEUP AIR UNIT __j OVEN ] i POOL HEATER r ; . 11, { ROOM I SPACE HEATER ---m , a ROOF TOP UNIT ______ '` TEST 3 UNIT HEATER ., I j UNVENTED ROOM HEATER WATER HEATER OTHER 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 W 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 thei Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT r.t:, 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 1;;ertineil provision o'the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.Li 4 / PLUMBER-GASFITTER NAME LICENSE# //639 SIGNATURE MP 511 MGF❑ JP ❑ JGF 0 LPGI 0 CORPORATION tl It 2735 PARTNERSHIP❑It LLC 0# COMPANY NAME ? 5 04EC'VilciViGAL --Ht.0 ADDRESS 5171 i 5v AA AA �� S7W: CITY D t X t3v,,L,1 STATE M A ZIP C "L33 TEL TEL Tyr ,.:2^ ° 3 FAX 7?r` T3,--803 4 CELL 7 S I` .20(0._'r9 33 EMAIL PSMAECVAavi i4{.(�� N'Cilg 77 1ne:T