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HomeMy WebLinkAboutBLDP-22-000446 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i;'` CITY YARMOUTH MA DATE 7/23/21 PERMIT# BLDP-22-000446 ti JOBSITE ADDRESS 24 LAKE RD OWNER'S NAME HULSE HAROLD V TRS OWNER ADDRESS HULSE GLORIA R TRS 107 SANBORN LN READING,MA 01867-1012 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:El 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 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 El BOND El 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 CHRISTOPHER BRIGGS LICENSE MA SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME Briggs&Heino Co.Inc. ADDRESS 36 Rolling Hitch Road,P.O.box 538 CITY Centerville STATE MA ZIP 02632 TEL 5087780816 FAX I I CELL 5084002529 EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK jtrf CITY IYARMOUTH MA DATE (July 23,2021 'PERMIT# BLDG-22-000447 JOBSITE ADDRESS 124 LAKE RD I OWNER'S NAME IHULSE HAROLD V TRS G OWNER ADDRESS IHULSE GLORIA R TRS 107 SANBORN LN READING MA 01867-1012 I TEL I I TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ElRESIDENTIAL CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 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❑ 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 ICHRISTOPHER BRIGGS I LICENSE# 112901 I SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG' 0 CORPORATION❑#( I PARTNERSHIP ❑#I ILLC ❑#I I COMPANY NAME: 'Briggs&Heino Co.Inc. I ADDRESS. 136 Rolling Hitch Road,P.O.box 538, CITY (Centerville 'STATE (MA I ZIP 102632 I TEL 15087780816 FAX 1 CELL 15084002529 1 EMAIL 1