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HomeMy WebLinkAboutBLDP&G-20-005892 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK "g101-0:1 CITY/TOWN S Yarmouth MA DATE 3/16/20 PERMIT#/� �� JOBSITE ADDRESS 40 Fresh Brook Road OWNER'S NAME Joshua Bing OWNER ADDRESS 40 Fresh Brook Rd, S Yarmouth, MA 01464 508-479-7472 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-0 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 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 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 ® 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. 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 a e and accurat best of y knowledge and that all plumbing work and installations performed under the permit issued for this application will be i o pliance-wi P ent pro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Dave Houde LICENSE#16673 SIGNATURE MP® JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME David D Houde ADDRESS 1016 Queen Anne Road CITY Harwich STATE MA ZIP 02645 TEL FAX CELL 508-292-6417 EMAIL davidhoude6@gmail.com �Ir 1 � � r,J • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK S Yarmouth CITY MA DATE 3/16/20 PERMIT# 77%/)/'_ L� "CV JOBSITE ADDRESS 40 Fresh Brook Road OWNER'S NAME Joshua Bing G OWNER ADDRESS 40 Fresh Brook Rd, S Yarmouth, MA 0iN64 508-479-7472 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT: ® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z 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 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY ❑ BOND El 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 El AGENT El 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. 711,02,6)y14 G��/� PLUMBER-GASFITTER NAME James E McDonnell LICENSE# 5076 SIGNATURE MP❑ MGF❑ JP❑ JGF® LPGI ❑ CORPORATION ❑# PARTNERSHIP❑# LLC❑# COMPANY NAME McDonnell Mechanical Services, Inc ADDRESS 79 School Street CITY W Dennis STATE MA Zip 02670 TEL 508-394-0005 FAX 508-394-5050 CELL 508-246-3152 EMAIL barbara@mcdonnellmechanical.com