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HomeMy WebLinkAboutBLDP&G-23-004354 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 'YARMOUTH 14,„ j I MA DATE I2/7123 I PERMIT# BLDP-23-004354 JOBSITE ADDRESS 122 WHITES PATH I OWNER'S NAME(DAVENPORT DEWITT TR p ADDRESS DAVENPORT REALTY TRUST 20 NORTH MAIN ST SOUTH YARMOUTH,MA I TEL P OWNER 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES El NO❑ CLEARLY NEW: ❑ FIXTURES 1 FLOORS---. RSM 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: YES 0 NO 0 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT e d accurate to e best of my I herebywld certify that all of uhmbidetails ork and installations n allat ons performed under theormation I have submitted or ered regarding this application are permit issued for this application will be in compliance with all Pertinent provision nowledas and that all plumbing of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. SIGNATURE TroyGilbert LICENS:1f3573 PLUMBERS NAME [ PARTNERSHIP 0# [J LLC 0# MP . © JP El CORPORATION 0# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY Cril STATE IENNIIIIIII ZIP 025711324 TEL FAX CELL EMAIL katherine@coastalphc.com .r . -:. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , w;=er =:Ff=1 CITY Yarmouth I MA DATE 1/31/2023 I PERMIT# Z JOBSITE ADDRESS 22 Whites Path I OWNER'S NAME 22 Whites Path LLC 1 GOWNER ADDRESS 21L Fruean Ave Yarmouth MA 1 TEL 508-737-8747 1FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Li RESIDENTIAL( PRINT CLEARLY NEW:Li RENOVATION:ICJ REPLACEMENT:® PLANS SUBMITTED: YESLJ NOLJ APPLIANCES- FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER I COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE I i � � FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT =I OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT I TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER I I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li NO Li I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE INDEMNITY _I BOND Li 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. CHECK ONE ONLY: OWNER AGENT Li 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. 12.49 de PLUMBER-GASFITTER NAME Troy Gilbert LICENSE# 13573 I GNATURE MP Li MGF Li JP Li JGF 1 LPGI Li CORPORATION J# 1 PARTNERSHIP LPL I LLC 1, J# 4350 I COMPANY NAME: Coastal Mechanical I ADDRESS 21L Fruean Ave CITY S.Yarmouth I STATE MA ZIP 02664 ITEL 508-737-8747 FAX— CELL EMAIL Katherine@coastalphc.com