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Home My WebLink AboutBLDP&G-22-005105 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11- .1-=; CITY YARMOUTH MA DATE March 15,2022 PERMIT# BLDG-22-005105 JOBSITE ADDRESS 166 SPRINGER LN OWNER'S NAME Frank Zappula G OWNER ADDRESS _ I 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 1 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 2 OTHER DESCRIPTION:pizza oven gas main upsize 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 Troy Gilbert LICENSE# 25383 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: TROY J GILBERT ADDRESS. 39 STATION ST,39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 - TEL 7 FAX CELL EMAIL katherinena coastalphc.com S310N M3IA321 NVId #1MN3d $:33H ❑ ❑ LINi13d 3H1 SV S3A213S NOIlVDI-IddV SIHI ON S&A S310N N01103dSNI 1VNId AINO 3Sl 210103dSNI 210d 3OVd SIHl S310N N01103dSNI SVO H0l0M MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w F CITY YARMOUTH MA DATE 3/15/22 PERMIT# BLDP-22-005106 Ir JOBSITE ADDRESS 166 SPRINGER LN OWNER'S NAME NEU STANLEY E P OWNER ADDRESS NEU K DIANE PO BOX 45 MANLIUS,NY 13104-0045 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 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 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. 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 Troy Gilbert LICENSE 25383 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME TROY J GILBERT ADDRESS 39 STATION ST 39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherine@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVE AS THE ❑ ❑ nrnaarr FEES$ PERMIT# PLAN REVIEW NOTES v, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1. ' CITY _ Yarmouth MA DATE 03/07/2022 PERMIT# • �"' • 6.1' 166 Springer Lane West Yarmouth MA 02673 Frank Za ula JOBSITE ADDRESS OWNER'S NAME pp POWNER ADDRESS 166 Springer Lane West Yarmouth MA 02673 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL I I RESIDENTIAL il PRINT CLEARLY NEW: l RENOVATION: ®' REPLACEMENT: ^ PLANS SUBMITTED: YES Li NO FIXTURES -1 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/OIL/SAND 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 Outdoor Kitchen Sink 1 _ Water Piping For Outdoor Kitchen 1 _ 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 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. 1(96)1a41 CHECK ONE ONLY: OWNER ' AGENT ❑ SIGNATURE OF OWNER OR AGENT l 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � — PLUMBERS NAME Troy J Gilbert LICENSE # 25383 & GNATURE MP ❑ JP1 CORPORATION "#4350 PARTNERSHIP ❑ # LLC [1 # COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY Yarmouth STATE MA zip 02673 TEL 508-737-8747 FAX CELL 508 850-6955 EMAIL Katherine@Coastalphc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ti .r city: Yarmouth MA. DATE 03/07/2022 PERMIT# 2 " SIof JOBSITE ADDRESS: 166 Springer Lane OWNER'S NAME: Frank Zappula GOWNER ADDRESS:166 Springer Lane West Yarmouth MA 02673 TEL FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL'f PRINT r-�/ CLEARLY NEW:❑ RENOVATION:a." REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO{i APPLIANCES? FLOOR—, Burnt 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 1 ✓' INFRARED HEATER W LABORATORY COCK MAKEUP AIR UNIT _ , q OVEN POOL HEATER ROOM I SPACE HEATER • _ -J ROOF TOP UNIT TEST .Z UNIT HEATER tyJ UNVENTED ROOM HEATER WATER HEATER Gas Main Upgrade 1 Gas Piping To Pizza Oven 1 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 have checked Y 5,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY V OTHER TYPE 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 thaa/t my signature on this permit application waives this requirement. /,2 CHECK ONE ONLY: OWNER'( AGENT❑ SIGNATURE OF ER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this app§cation 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 wIt be In compliance with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. /� PLUMBER/GASFITTERNAME: Troy J Gilbert LICENSE#25383 QsiGaTURE COMPANY NAME: Coastal Mechanical ADDRESS: 21 L Fruean Ave CITY: S.Yarmouth STATE: MA ZIP: 02RR4 FAX: TEL: 508-737-8747 CELL: 508-850-6955 EMAIL: Katherine@Coastalphc.com MASTER❑ JOURNEYMAN❑ LP INSTALLER❑ CORPORATION'#4350 PARTNERSHIP❑# LLC❑# E 09DDiee s: