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HomeMy WebLinkAboutBLDP&G-22-005404 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rtICITY 'YARMOUTH MA DATE March 28,2022 1 PERMIT# BLDP-22-005404 r�, JOBSITE ADDRESS (PINE ST I OWNER'S NAME BSA Cape Counsil G OWNER ADDRESS SOUTH YARMOUTH MA 02664-0463 TELI TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—s 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❑ 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 Curtis Sears LICENSE It 10175 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG] ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: CURTIS F SEARS ADDRESS. Po Box 370. CITY Yarmouth Port STATE MA ZIP 026750370 TEL FAX CELL 5083620656 EMAIL none ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES F I>AASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING I+IG WORK CITY "(,i ��s ( vl ri L MA DATE 3/2 J�,2 PERMIT fr JOBSITE ADDRESS c,9? p',,f E sj I� G 7 4 OWNER'S NAME c l � CG ___ ` • OWNER ADDRESS GJr Ito0 sr Y ; 9 TEL FAX TYPERINT OR P OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 0 RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ 1d0❑ APPLIANCES 7 FLOORS-4 BSM 1 2 3 1 5 6 7 0 BOILER - 9 10 11 12 1; 1, BOOSTER I CONVERSION BURNER I l 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 T VERAGE I have a current Iiabili insurance policy or its substantial equivalent INSURANCE O 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 0 • 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 that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENTCHECK ONE ONLY: OWNER 0 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. ii1 PLUMBER-GASFITTER NAME - �-� LICENSE# /viol_?s_ SIGNATURE MP E MGF❑ JP 0 JGF❑ LPG' ❑ CORPORATION❑It PARTNERSHIP 0 it LLC❑It COMPANY NAME L1--021-1S Sc.- ( ADDRESS t d ". 37ci CITY }!T;7-4►'10 pf2A— STATE /f'14- ZIP 42-4: 7- FAX TEL :S?r�- 3Co2 —CGS CELL EMAIL INSFE+ C' 'I���I I�13 E�� THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 1 1 I FEE: $ PERMIT # PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 9 �r. CITY YARMOUTH MA DATE 3/28/22 PERMIT# BLDP-22-005404 'Val::: JOBSITE ADDRESS PINE ST 1 OWNER'S NAME BSA Cape Counsil P OWNER ADDRESS SOUTH YARMOUTH,MA 02664-4463 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT El PLANS SUBMITTED: YES El 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 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 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 Fits Seam LICENSE 16175 I SIGNATURE MP El JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CURTIS F SEARS ADDRESS Po Box 370 CITY Yarmouth Pod STATE MA ZIP 026750370 TEL FAX CELL 5083620656 EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY X/I'4-Yl4 a v l� MA DATE 3 Z-ri 2 z PERMIT# JOBSITE ADDRESS Z? IL,/ S Y /l U OWNERS NAME /->S4 ✓‘- t L OWNER ADDRESS Ltt L I vcvs i Y . TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL r PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[24 PLANS SUBMITTED: YES❑ NO❑ 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM 1 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 r • 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 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POUCY ❑ : 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. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ r - 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 comp• cue with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# f(.1/ 7.t' SIGNATURE MP© JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME C�21 t S S`L'1.A.C I ADDRESS >�w X -3 7 4.-' CITY yf/=v'fr1 o��p�,v1 STATE/I2 ZIP Ct 7J - TELSOK - Cl - CZ c FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES •