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HomeMy WebLinkAboutBLDP-22-006138 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/26/22 PERMIT# BLDP-22-006138 JOBSITE ADDRESS 229 OLD MAIN ST OWNER'S NAME DOWD ROBERT K P OWNER ADDRESS 3141 HOOD ST SUITE 650 DALLAS,TX 75219-5026 TEL ] TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES • FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1VL. 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 Edward Roy LICENSE 18403 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME EDWARD C ROY ADDRESS PO BOX 583 CITY SPENCER STATE MA ZIP 015620583 TEL FAX CELL EMAIL roysplumbingheating.drains@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT N PLAN REVIEW NOTES 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -—'�f= 7 CITY 56414 -Gr'yo 014 A MA DATE 2,S z - PERMIT# Z-1-" ( 3g JOBSITE ADDRESS p2o29 ad /714/0I —f OWNERS NAME frrk,rir 'r 1 ) P OWNER ADDRESS S 4/YI e TEL a ISM r 351-,5-9/ FAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-4 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 f , DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN , INTERCEPTOR(INTERIOR) KITCHEN SINK ' LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK _ TOILET URINAL / - , _ WASHING MACHINE CONNECTION V WATER HEATER ALL TYPES WATER PIPING a OTHER — i r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND ❑ w 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 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 oft y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in coilance with all Pertinent pro, io, ' i e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. s 11'4":1 PLUMBER'S NAME LICENSE# /31/C_j. ( SIGNATURE / MP❑ JP❑ CORPORATION 0# PARTNERSHIP❑.# LLC III# COMPANY NAME Rd1S )ivt "b4..nl l � ADDRESS .2 Y (", 4/C"1 5 1 CITY 5pewc-ev STATE ZIP TEL i1 Y-772 '"fo f FAX CELL EMAIL j aySP1 pn49 if()tit Al . D 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ;',1 • � CITY YARMOUTH MA DATE April 26,2022 PERMIT# BLDP-22-006138 JOBSITE ADDRESS 229 OLD MAIN ST OWNER'S NAME DOWD ROBERT K ] G OWNER ADDRESS 3141 HOOD ST SUITE 650 DALLAS TX 75219-5026 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 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 Edward Roy LICENSE# 13403 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP El# _LLC ❑# ] COMPANY NAME EDWARD C ROY ADDRESS. PO BOX 583, ] CITY SPENCER STATE MA ZIP 015620583 TEL ] FAX CELL EMAIL roysplumbingheatinq.drainsangmail.com ] S310N M3IA321 NVId #lIW2i3d $:33d ❑ ❑ 11M13d 3H1 SV SBA213S N011V31lddV SIHI oN seA S31ON N01103dSNI 1VNId AINO 3Sfl a0103dSNI NOd 30Vd SIHl S310N N01103dSNI SVO HJf1ON 'i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �. ,s" CITY rm U '4w,'' n Mr, DATE PERMIT* 2Z /3 S JOBSITE ADDRESS 92,97 I' Ca /144M/ 9- OWNER'S NAME M fe GOWNER ADDRESS TEL aTEL / 3 y, .5 j'? ,x "�` TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL E ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ] REPLACEMENT: Er/ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS BSM 1 _, 3 4 5 6 BOILER y to 1'I 12 I3 �,, 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 I .--�— UNVENTED ROOM HEATER WATER HEATER •OTHER V —'�— INSURANCE ERAGE I have a current liabili insurance policy or its substantial equivalent which Ovmeets 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 ❑ LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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 CHECK ONE ONLY: OWNER ❑ AGENT El 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 plumbingwork pp p and installations performed under the permit issued for this application will be in compile a with all Pertinent pro ' i of . g Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1, PLUMBER-GASFITTER NAME LICENSE# SIGNATUR MP❑ MGF❑ JP El JGF❑ LPG! El CORPORATION❑#F PARTNERSHIP❑# LLC 0#i: COMPANY NAME 1� ) 1 ADDRESS �^ 7 e 1 ti re.4 5 t CITY_ ��eWL-tt' STATE Sf ZIP 0/) �a FAX � � TEL 2 yr _77a '/G��/j 9 CELL EMAIL -..• .`.., I I i { { Vi H 0 4 I Cl( H I Dr. I r.-. I � I I I 1 I I 0 _ QD I c >- rii G. 2 �"' 0w 0 I r - I P., `— a c1 � c : w U 1 GO < Q C) r-.I a- \ i'""i Q., Gn l.6 t I I 1 H 1 C) 0 I 1 U.,) 1 1 1 I Z . L�pJ 14 { 1 i