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HomeMy WebLinkAboutBLDP-23-000453 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK (�, c CITY 'YARMOUTH I MA DATE 17/28/22 I PERMIT# BLDP-23-000453 r � - l' s� I OWNERSJOBSITE ADDRESS 137 TAFT RD NAME ISPARIOSU JOHN P OWNER ADDRESS 137 TAFT RD WEST YARMOUTH,MA 02673 1 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES El NO❑ FIXTURFS • FLOORS--0 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 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 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 Ijoshua ferreira I LICENS:16948 SIGNATURE MP © JP ❑ CORPORATION ❑# I � �J PARTNERSHIP 0# LLC ❑# COMPANY NAME ferreira plumbing and heating ADDRESS 2 hathaway rd CITY Berkley STATE MA ZIP 02779 TEL 7742632391 FAX CELL 7742228219 EMAIL ,� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK it e", CITY 'YARMOUTH I MA DATE (July 28,2022 I PERMIT# BLDG-23-000454 JOBSITE ADDRESS 137 TAFT RD I OWNER'S NAME ISPARIOSU JOHN G OWNER ADDRESS 137 TAFT RD WEST YARMOUTH MA 02673 TYPE OR I TEL I OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT El CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED:YES © NO❑ FIXTURES FLOORS—. BSM 1 2 BOILER 3 4 5 6 7 8 9 10 11 12 13 14 BOOSTER • CONVERSION BURNER COOK STOVE DIRECT VENT HEATER • DRYER FIREPLACE • FRYOLATOR FURNACE 1 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 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 0 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 LICENSE# SIGNATURE MP❑ MGF 0 JP 0 JGF 0 LPGI ID CORPORATION 0#I I I PARTNERSHIP ❑# JLLC 0#I I COMPANY NAME: I ADDRESS. CITY I I I STATE I I ZIP I-- TEL FAX 1 CELL EMAIL