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HomeMy WebLinkAboutBLDP&G-22-007245 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k , CITY YARMOUTH MA DATE 6/15/22 PERMIT# BLDP-22-007245 JOBSITE ADDRESS 125 RUN POND RD r� dv_ OWNER'S NAME ALBERINI BENITO R P OWNER ADDRESS ALBERINI BERNICE C PO BOX 303 ASHLAND,MA 01721-0303 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT 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 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 ❑ 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 (Mark Shahood I LICENSE'tb862 I SIGNATURE MP ❑ JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I J LLC ❑# I I COMPANY NAME (MARK S SHAHOOD I ADDRESS 11091 WAVERLY ST I CITY IFRAMINGHAM I STATE IMA I ZIP 1017028410 I TEL FAX 1 I CELL I I EMAIL info@shahoodplumbing,com S310N M3IA3N NVld #1IWN3d $S33d 0 0 3H1 SV 3AN3S NOI1V3IlddV SIH1 oN saA S3ION NOI133dSNI 7V03 A'INO 3Sfl 3313301103 MO13 I S31.ON NO1I 1dSNI ONIIIIAtf1'Id H9f101I . . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY S.Yarmouth __�sra_ cu4f fMA DATE 6/1D/22 PERMIT# `L2 '7ZH JOBSITE ADDRESS 125 Run Pond Rd. OWNER'S NAME Sheeran OWNER ADDRESS 125 Run Pond Rd. TEL ._._ !FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: a PLANS SUBMITTED: YES NO FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 BATHTUB III to 11 13 to CROSS CONNECTION DEVICE1 DEDICATED SPECIAL WASTE SYSTEM IIIIIIIIIIIIIIIIIIII� DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM ■■ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM111111111111111 III 111111111111111111 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 ALL TYPES III WATER PIPING OTHER _ . ... , _ _ , -- - , A ..., NM Ell MIN INIIIIIIM11111111111■ =Ai ■ INSURANCEGE: I have a current liability insurance policy or its substantial � q e uva ent wh ch mee s t euirements of MGL Ch.142 YES re . NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v 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 CHECK ONE ONLY. OWNER - AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application .. and that all plumbing work and installations performed under theg llbinareo true and wit to best of my knowledge permit issued for this application vriU be compliance wit -rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MARK S.SHAHOOD JR. `LICENSE# 15862 SIGNATURE MP - JP CORPORATION - #3469 PARTNERSHIP # LLC # COMPANY NAME T.SHAH00D&SONS ...._.....w__.. ADDRESS 1091 WAVERLY ST. CITY FRAMINGHAM MA STATE ZIP 01702 _ TEL 508-875-3413 1 FAX CELL 508-808-4223 EMAIL INFO@SHAH00DPLUMBING.COtv1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `r 1 CITY YARMOUTH MA DATE (June 15,2022 I PERMIT# BLDP-22-007245 )f ` JOBSITE ADDRESS 125 RUN POND RD OWNERS NAME ALBERINI BENITO R G OWNER ADDRESS ALBERINI BERNICE C PO BOX 303 ASHLAND MA 01721-0303 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL IZI CLEARLY NEW: 0 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 0 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 'Mark Shahood I LICENSE# 115862 I MP© MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION 0#I I SIGNATURE PARTNERSHIP ❑#I ILLC 0#I I COMPANY NAME: IMARK S SHAHOOD I ADDRESS. 11091 WAVERLY ST, I CITY IFRAMINGHAM I STATE IMA I ZIP 1017028410 I TEL I FAX I I CELL I I EMAIL infot7a.shahoodplumbing.com I I S310N M3IA3 I NYld #.11Mad $:33d El El 1IW213d 3H1 SV S3AIES NOIIVOI1ddV SIHJ oN saA S310N NOI103dSNI 1VNI3 N NO 3Sfl O103dSNI 2IOd 3OVd SIHl S310N N01103dSNl SVO HJf102i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY S.Yarmough _y__ .._» MA DATE 6/10/22 _ .-. .....,.._ PERMIT# JOBSITE ADDRESS 125 Run Pond Rd OWNER'S NAME OWNER ADDRESS 125 Run Pond Rd TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT. PLANS SUBMITTED: YES NO APPLIANCES-1 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 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - 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 the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: 0 N AGENT I hereby certify that at of the details and information I have submitted or entered regarding this application are true and accur o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME MARK S.SHAHOOD JR. LICENSE# 15862 w SIGNATURE MP - MGF JP JGF LPGI CORPORATION - # 3469 PARTNERSHIP LLC # COMPANY NAME:T.SHAHOOD&SONS . LL ADDRESS 1091 WAVERLY ST. CITY FRAMINGHAM -- -- I STATE MA ZIP 01702 TEL 508-875-3413 FAX CELL 508 808-4223 m-�- `EMAIL INFO@SHAHOOQPLUMBING.COM i I t