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Home My WebLink AboutBLDP & G-22-004081 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/24/22 PERMIT# BLDP-22-004081 �i JOBSITE ADDRESS ik,r_t 63 DRIVING TEE CIR OWNER'S NAME Dillon Hoyt P OWNER ADDRESS 63 DRIVING TEE CIR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES NO El FIXTURES 1 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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 (Michael Mcbride J LICENSE149681 I SIGNATURE MP 0 JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC El# I I I COMPANY NAME IMICHAEL R MCBRIDE I ADDRESS 19 Rustic Drive CITY (West Yarmouth I STATE IMA I ZIP 102673 I TEL I I FAX I I CELL I I EMAIL Istinger,mcbride@gmail.com I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r -= 1-V CITY 4 _ '. r ekl' MA DATE AW e e--2 PERMIT# 2l— (-WI( Yt i JOBi9E ADDRESS 4, f l i✓,r 1' r- Le OWNER'S NAME, t )J1v\ (/Vl11) 7-e JAt 4 OWNER ADDRESS J (.� FAX �� FAX LBy .i"r ,P OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL � AK1�viENT C'LRty E1N: ] RENOVATION:❑ REPLACEMENT:2 PLANS SUBMITTED: YES❑ NO gJ FIXTURES 7. FLOOR—+ 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/OILISAND SYSTEM J DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER —~ DRINKING FOUNTAIN f FOOD DISPOSER —, FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN _ ' SHOWER STALL SERVICE 1 MOP SINK TOILET j URINAL _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 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 'l- 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 ��,L 0 t� `r, -` -� (4 i LICENSE# SIGNATURE MP❑ JP 0 CORPORATION❑# PARTNERSHIP❑.# •Priv P LLC❑# Jh 1 LCOMPANY NAME C1,1,. (. (,f O 4---11 ADDRESS 37 /�=ginIi lin Lie CITY L' ` �/ Ca Z _—�. ---,/ ck f1 M i 5 STATE 4 C ZIPLZ., G/ TEL 7 7 / 'Si 0 // FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " riMA DATE January 24,2022 PERMIT# BLDP-22 004081 CITY YARMOUTH JOBSITE ADDRESS 63 DRIVING TEE CIR OWNERS NAME Dillon Hoyt G OWNER ADDRESS 63 DRIVING TEE CIR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 I 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 0 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 (Michael Mcbride I LICENSE# 119681 I SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG( ❑ CORPORATION❑# PARTNERSHIP 0#I ILLC ❑#I COMPANY NAME: 'MICHAEL R MCBRIDE I ADDRESS. 19 Rustic Drive, I CITY (West Yarmouth I STATE IMA I ZIP 102673 I TEL I I FAX I I CELL I I EMAIL Istinger.mcbride anpmail.com I Iii , ' ii CHLISETTS UNIFORM APPLICATION FOR A PER FT TO PERFORM GAS FITTING WORK 4 2 4 T�,� k I MA DATE I 21 Z.� `' PERMIT# 1-1 " Lt 0&'t L_- , JOBSITEj;D ,R.ESS l 0 et'LI/AD -7----Ea, Circ/IeOWNER'S NAME PUi 4u DE 2 1 NT 4- 2 ----L=Ci�4ttZR AW.OESS TYPE 76 r TEL 6//— / ) FAX RINT OCCUPANCY TYPE COMMERCIAL LiEDUCATIONAL ❑ RESIDENTIAL ❑ CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES T FLOORS—' sSM 1 ? 3 4 5 6 7 11 BOILER 9 !l t2 13 1,, 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 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 64. 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, �@ CHECK ONE ONLY: OWNER —1 AGENT ❑ .� SIGNATURE OF OWNER OR AGENT 'Ii-• 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 t& Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `i PLUMBER-GASFITTER NAME (1._` �.~`"y LICENSE# SIGNATURE MP ❑ MGF❑ JP a JGF❑ LPGI ❑ CORPORATION ❑# --7�PA.RTN HIP❑# LLC❑;t; COMPANY NAME i [ iLe D—l"-tt4 ADDRESS 73 I fi L CITY ei �'1 ' I STATE i v ZIP O �� O/ TEL c l ,., C FAX CELL EMAIL