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HomeMy WebLinkAboutBLDP&G-22-006098 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK um CITY YARMOUTH MA DATE 4/22/22 PERMIT# BLDP-22-006098 -ice C p JOBSITE ADDRESS 76 SILVER LEAF LN OWNER'S NAME FULMER DAVID T TR P OWNER ADDRESS SILVER-SUMMER TRUST 11576 MAIN ST WINCHESTER,MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ 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 Thomas Coughlan LICENSE 8629 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THOMAS J COUGHLAN ADDRESS 48 HERITAGE DR CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITH PLAN REVIEW NOTES MAP .' P.qgC6( , . % _- '1 1 SIACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . / -_:,ice, - . ... I I - I MA DATE PERMIT# 2 Z - u �;���-- CITY �.� - - C (--!� OWNER'S NAME JOBSITE 4DDRESS 76_ 5/0. sec -__ BUIL G CEP By: AUCIRESS TEL ____-__. __-._.__ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL 71 RESIDENTIA J PRINT CLEARLY NEW: 0 RENOVATION:J REPLACEMENT: PLANS SUBMITTED: YES 0 NO 1 FIXTURES -IFLOOR -► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( 1__ _ _ ._.1L.__4.... r_�J%_,.s. �. 1 ,Ifz_, .-._. _. I_R �__..... L--,Jf..,:..� _ 3r � q l CROSS CONNECTION DEVICE 1. _J,„_,___.�� 1. ��. -�...,L-.�Ji, ...� � ,_1 ____,:,..�� �i� . .,. DEDICATED SPECIAL WASTE SYSTEM 1. j,._. _1 ___.-1 �. lL ..,.....J.,„_____-- . L . 11,.-,1 =1�,.._ ' DEDICATED GAS/OIL/SAND SYSTEM {..,.,_. ! _Ls,=- I —I. €—- 1_, f. i'----_JL JJ--- -1 L. DEDICATED GREASE SYSTEM al, L______.. ____L- =___ '�---r -� " DEDICATED GRAY WATER SYSTEM ( I�.=f � . �. la.- - -• 3-r-A - xDEDICATED WATER RECYCLE SYSTEM '•[ I 1�_i -•.• _�� J=1 - -_- 1�-= -6 - i�` `I .,�ac�.�a++..-..,_mil �_.�-.•e.s-:{{t.tsL v>�.. aJ If it 1 `y� I 1 ! _J 3. `n—(I.o c-,�=1 11„_3 i -� -I I J Lam. ..aI _i i_s L+..rnv.--+, c__,... _DISHWASHER �.� ------ -!� DRINKING FOUNTAIN 1 1[ 1 .>I - ...,__-1� - {::: � �-� ,, J -71 ` __..,:'��:�-I FOOD DISPOSER I^.,. 1 _ ! 1-�-,__ T,T-.,�-. L-.�..-_J`-.�r J.�-.:JL�� . .r_. LJ - .��I_,_":.. FLOOR/AREA DRAIN I t? �._ II - - - . '��I(�°` •m-d`.�I�TIM �1 INTERCEPTOR (INTERIOR) °Fi �- i KITCHEN SINK 1 at—t--11 i',.-- ' I! ,...._ .s41 . =i,. - 1i._ i - t LAVATORY 1� _ �_ =_1I �__1, . _,AL . 1=C-11 �L 1? 1r �.,.-...�.� ._. _ ROOF DRAIN `1-m--J` I_.� ,I_...��. �,� it..:- -_1 _ .J, - _... _ ,._____ j, SHOWER STALL - .-- —� 1�- IL_ __ ��-�- x! SERVICE / MOP SINK L L .. E:. L- .,.- La.,... {` 1 J► _J1 . C _ I.__-, L,..JL.,__ I I r {L.�-+�. .f�sb� -.-r l+a.�r�.:�l_ - _ 'I -ram'L... - `-.i.aYu�' -t{"�' ,..___._.T I v -- .Vlb a� f,7-Z_--v_, TOILET .u'(_......_._.11 j 1 __ _ � = 1, URINAL , ! 1�..�.._ i -._ I � !�,,.♦„_..�L��« __�= .. ..�r IL..�M..1i WASHING MACHINE CONNECTION - '. -I L__ 1I.__.- ..iL:..-j:rl�__. JL__r_..=. 1�___IL.��-.�.-�.IL..�.�� _ . ._ WATER HEATER ALL TYPES j� --17----.�1=L- I`:.� `i srt--._-1�.��:.wl.., ' £ i 1-�. - WATER PIPING l�_ _ JI._>....,IL _ IL� 11____ �� is �u.1l.,.�.- �� ;i. _ L...._ - -: OTHER .� I L. �_ >* .jI,�-H + - -HIHTTF± Is - 'slh�= 'gr. Z w n+.><aa - 1;r�...._.a-.>< lanr<',crI+vim Sa'_'u''1___ 3 ! I --�ter.....-.�..�.=�X�ai.—'.'�_ ,..� I � i I II �J —6} �� i I i I��1 1 f....,.r.a--a.r- ..�s�r�-4 L-c=.c--rwc,•laa.�.....-J �asK....._-_..-_�-�.'--+• _. _ [1 `� - -- R -.�11 .t..t-+...+.�.':�.-......�->.s�1 t .�..rW>.c� ..�.,.�wcr_ INSURANCE COVERAGE: I have a current liability insurance policy olic or its INO bstantial equivalent which meets the requirements of MGL Ch. 142. YES [:::1 , 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 El OWNER'S INSURANCE WAIVER: I am aware th.t 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 Lj AGENT 0 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 permi issued for this application will be in c pliance with all Pert)pert provi ' of the Massachusetts State Plumbing Code and Chapter 142 of the Genera aws. _ r PLUMBER'S NAME �j '� - - 1 LICENSE # 24 SIGNATU • iv- MP JP( "15 al CORPORATION[,L# a'PARTNERSHIPU#L ( LLC:# COMPANY NAME 111090 06 kat,' t s•- ? ADDRESS + . - . _ - , A CITY k ' i ' r" 0, .‘ ,._.-, 1 STATE LL2Ldt '_ZIP �J _.-. TEL S `:22 ���/� FAX L --------__ -CELL EMAIL 4 44 ( . r 6"4 4 - ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:S PERMIT# PLAN REVIEW NOTES op • l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .......................... _ ILLI)2' CITY YARMOUTH MA DATE April22,2022 PERMIT# BLDP-22-006098 JOBSITE ADDRESS 76 SILVER LEAF LN OWNERS NAME EULMER DAVID T TR G OWNER ADDRESS SILVER-SUMMER TRUST II 576 MAIN ST WINCHESTER MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ 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 El 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 Thomas Coughlan LICENSE# 8529 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL S31ON M31A32i NVld #11M3c1 $ :33d El ID 1I012:13d 3H1 SV S3AH3S NOI1V3flddd SIHI oN saA S310N NOI103dSNI 1VNId AlNO 3Sfl H0103dSNI el0d 3OVd SIHI S310N NO1103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1:- i---I n - - - 2Z- �v (bl.� M�Otit MA DATE ;-}� PERMIT# - ,.- JOBS -E'. •.: 76 DC✓M11-.6 611-1 L1144OWNER'S NAME ' -.___.._1 'PR mW it24DD E • TEL _ —�FAX L Titer OR © . 'i c F 1PAN NT •E COMMERCIAL; EDUCATIONAL J RESIDENTIAL • ..- -:NOVATION::_.J REPLACEMENT:)' PLANS SUBMITTED: YES.J N01 APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _J___1_____J_�I_I_,j_1_J J-J___ I____J I_J_J BOOSTER -J___I ! 1 I t_I-J J_I.-J J-I_1_J CONVERSION BURNER _I I _ I I_) j•_J, I ___1__J _ J I_I___I_�___J____JCOOK STOVE _ ! I___I___I_ I I I-) -J-J J-J-J-1 DIRECT VENT HEATER •__I___1_J J;__I.- 1_J___4_,____(_J I-_J j_I J DRYER- -�J-_J_1 I -J _-J 1 I—I _I-_1 FIREPLACE ,___1._ .I____J.,_1 I. —i__J:_J I I I I I I___J FRYOLATOR ,J r _ FURNACE :-J. I.-J._1 I _ :_ . . ! _,i-J_-I.,_.1--1 _�I—J__II__.I-J I I _____JI---._1 _I 1 GENERATOR Iqi 1 - GRILLE _i_�,,_ _ 1____I i_J_-J.___J__J__1_J, -Y1_YJ-___J INFRARED HEATER J J J _1 1 _1^J_� _...1_ 1 __I 1— I LABORATORY COCKS ( 1-i 1._.�1 _ ___._1 I_ `I___J___J_J___J__1___I MAKEUP AIR UNIT '____„j I_._1_J_1___._I ___J ___I I__[ I__I__I OVEN I____I i - I ( _-_J___.I.__ _I, i _____J 1___.-.1--i_-J i POOL HEATER ,J-_J_____J__I.___I___I____I.__ I I___I______I__I_. I_J_____1 ROOM/SPACE HEATER I l,_� J I I i_ I___I 1 I I i__J _1 1 ROOF TOP UNIT ._I ___J__ I f___J I I_____J -J_r.J J-J TEST _I j i_ I 1 i.__._.I ; l ;- 1 I i UNIT HEATER ' i___._1 ______I i_.___.J `i _J i ______I —J _ tI UNVENTED ROOM HEATER I ____1i .._______ii_ __.Jr -_ ;_ I I ___J I ___1 WATER HEATER - -_- - - . / I-J___LJ I_____i____I ':___.J�j-J I ,____I_J OTHER : I I -_I I -I_ ; I I Y J -_I-J___J__-(._J__J-J . I I -._1 ____I_._.I___.__I 1 .. I_ _..I_ I __I - _I- I I- I 1 _l___! _i_ ( - I. 1.r�J___1 !,_I _I I -- I_ .2 ... 1 INSURANCE COVERAGE CI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES CNO 1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY J BOND LJ 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 lLII AGENT J 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 bes of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in piiance with all --mine `;..vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME' /7/9 LICENSE#R S, -�/h, SIG •TURE MP(MGF',_J JP } JGF;J LPG' J CORPORATION J# 45`j 1 PARTNERSHIP_I# -—1 LLC J# -r COMPANY NAME:' )1-6 �'A t .- axAd1414)1 ADDRESS '"\ r l!I n r � I STATE, ZIP D)-- 7) 1 TEL 5-68 "7 3? - 0o I FAX EMAIL AIL"L(C, yi 3 �/1/`; 1 -'Jae-8/ �t'