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HomeMy WebLinkAboutBLDP-23-000459 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u AID- CITY YARMOUTH , MA DATE 7/28/22 PERMIT# BLDP-23-000459 II JOBSITE ADDRESS 8 TIMOTHY RD OWNER'S NAME GONCALVES WAGNER P OWNER ADDRESS MOTESSERRAT SHEILLA B 8 TIMOTHY RD SOUTH YARMOUTH,MA 02664 1\1ONTESbtR1711 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El 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 BATHTUB CROSS CONNECTION DEVICE 1 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 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❑ BOND❑ OWNERS 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 Craig Bishop LICENSE 1b101 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME High Efficiency LLC ADDRESS 378 Route 130 CITY Sandwich STATE MA —I ZIP 02563 TEL 5088253695 FAX CELL —1 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ 0 FEES$ PERMITH PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BLDG 23-000460 �, CITY YARMOUTH MA DATE July 28,2022 PERMIT# JOBSITE ADDRESS 8 TIMOTHY RD OWNER'S NAME GONCALVES WAGNER MONTESSERRAT G OWNER ADDRESS MOTESSERRAT SHEILLA B 8 TIMOTHY RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 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 I 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 © 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 Craig Bishop LICENSE# 15101 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG] ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: High Efficiency LLC ADDRESS. 378 Route 130, CITY Sandwich STATE MA ZIP 02563 J TEL 5088253695 FAX CELL EMAIL S310N M3IA321 NYld #11Wb3d $:33d ❑ ❑ 1111d3d 3E11 Sb S3A2:13S NOliV011ddd SIHl oN seA S310N N01103dSNI 1VN13 AlN0 3Sf1 d0103dSNI bOd 3OVd SIH1 S310N NOI103dSNI SVO HOflO i