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HomeMy WebLinkAboutBLDP-21-006805 F e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 71� CITY YARMOUTH MA DATE 5/24/21 PERMIT# BLDP-21-006805 I _ @ JOBSITE ADDRESSfik,z, 296 STATION AVE OWNER'S NAME DENNIS-YARMOUTH REG SCHOOL p OWNER ADDRESS 210 STATION AVE SOUTH YARMOUTH,MA 02664-3000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO m FIXTURES 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 2 2 DRINKING FOUNTAIN 6 6 FOOD DISPOSER FLOOR/AREA DRAIN 20 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 27 17 ROOF DRAIN 95 _SHOWER STALL 4 SERVICE/MOP SINK 3 3 _TOILET 35 22 URINAL 11 5 _WASHING MACHINE CONNECTION 1 _WATER HEATER WATER PIPING 1 1 OTHER 59 58 OTHER DESCRIPTION:Classroom sinks(55 on LV 1,54 on LV2) Ice Makers(4 on LV 1,3 on LV 2) 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❑ 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. PLUMBERS NAME `Patrick Harold 1 LICENSEI1Q459 I SIGNATURE MP 0 JP 0 I CORPORATION ❑# I I PARTNERSHIP El# I I LLC D# I 176 Clubhouse Drive I COMPANY NAME (Harold Brothers Mechanical I ADDRESS CITY (Hingham I I STATE IMA I ZIP 1020434888 I TEL 17742666354 I FAX I 1 CELL I 1 EMAIL I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�' = CITY 'YARMOUTH MA DATE May 24,2021 PERMIT# BLDG-21-006807 JOBSITE ADDRESS 1296 STATION AVE OWNER'S NAME DENNIS-YARMOUTH REG SCHOOL G OWNER ADDRESS 210 STATION AVE SOUTH YARMOUTH MA 02664-3000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL 0 PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO FIXTURES FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 3 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 15 TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 2 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 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-GASFITTER NAME 'Patrick Harold 'LICENSE# 12459 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' El CORPORATION❑#I I PARTNERSHIP ❑# LLC 0#1 COMPANY NAME: (Harold Brothers Mechanical I ADDRESS. 44,Woodrock Road, CITY 'Weymouth I STATE MA ZIP 102189 I TEL 17742666354 FAX 1 'CELL EMAIL 1