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HomeMy WebLinkAboutBLDP&G-22-007376 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/23/22 PERMIT# BLDP-22-007376 -tt J JOBSITE ADDRESS 518 ROUTE 28 OWNERS NAME SANDBAR HOLDINGS LLC P OWNER ADDRESS 518 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YESD NO 0 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❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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. PLUMBERS NAME David Houde LICENSE 16673 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑s COMPANY NAME ADDRESS 1016 Queen anne rd CITY harwich STATE Ma ZIP 026702445 TEL 5083940005 FAX CELL EMAIL davidhoude6@gmailcorn ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK T ,i-' f • r. -�— ' / ZZ- ? 3 7L 1_F•=y' CITY /a ✓�7�'"( MA DATE c(�y��a PERMIT# JOBSITEADDRESS .1—./lT6(71 "� �� �� OWNER'S NAME /"�t/'t`41.4., POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Er-- PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-+ BSM 1 2 3 4 5 6 7 B 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 • • r , _ ROOF DRAIN SHOWER STALL - SERVICE I MOP SINK TOILET j URINAL _ T _ 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 UABIUTY INSURANCE POUCY 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. •'t 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 are true nd accurate to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in is ce with al nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME CI c la 4,1 LICENSE# 76 6 2 ; SIGNATURE MP ll ---JP 0 //// h CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME j`-kt O /,' 4 ADDRESS /U/ 6 .0�e<'4. --41/rt CITY 714/-44-21 r7 STATE, ZIP 6..1 6 �[ 1.--- TEL 2 g.'"--01-9 e X''-'i 4(/, FAX CELL EMAIL (0 c" v( c/ #4 6 0 Gioia 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 kyCITY YARMOUTH MA DATE June 23,2022 PERMIT# BLDP-22-007376 JOBSITE ADDRESS 518 ROUTE 28 OWNER'S NAME SANDBAR HOLDINGS LLC G OWNER ADDRESS 518 ROUTE 28 WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO 0 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 0 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 David Houde LICENSE# 16673 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. 1016 Queen anne rd, CITY harwich STATE Ma ZIP 026702445 TEL 5083940005 FAX CELL EMAIL davidhoude6a.gmail.com S310N M31A32f NYld #±WW213d $:33d .LIV i d 3141 SV S3/183S N011VZIldd`d SIHl ON seA S310N N01103dSNI 1VNId AINO 3Sl 210103dSNI 210d 3OVd SIH1 S310N NO1103dSNI SVO HOflO I , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'if• ,:(s - :-- ,•._,` CITY j YvYv�� MA DATE i�`� ,Z\ PERMIT JOBSITE ADDRESS .CY �-- ��I(/s, / n OWNERS NAME 3c) �((irrti•xc GOWNER ADDRESS TEL FA? TTP)E+ OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALT DU�ATIOPJAL ❑ ❑ PS CLEARLY NEW;❑ RENOVATION: ❑ REPLACEMENT: PLAINS SUBMITTED: YES❑ NO E APPLIANCESFLOORS BEM1 1 3 1 5 6 5 9 11 11 12 '13 1! BOILER I BOOSTER --� CONVERSION BURNER —~ COOK STOVE —~ DIRECT VENT HEATER DRYER i FIREPLACE FRYOLATOR FURNACE —___i GENERATOR - GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT • - OVEN POOL HEATER • ROOM!SPACE HEATER ROOF TOP UNIT — ______I — TEST _ . - UNIT HEATER LINVENTED ROOM HEATER WATER HEATER OTHER - I 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL.Ch.'142 YES 'O ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA :BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ i 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 ‘ii-• I hereby certify that all of the details and information I have submitted or entered regarding this application are true an urate to the b t of my knowledge `-- and that all plumbing work and installations performed under the permit issued for this application will be in comp' e th all Partin ro ision of the �`' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Li PLUMBER-GASFITTER NAME LICENSE it 46)3 SIGNATURE MP Ind I IGF E JP ❑ JGF ❑ LPG' ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME 74`C4Al-- // ADDRESS /0/d c--Q 4'4, /c /r/'' CITY ilia 1-C.,...-r e < STAT (^ ZIP O o9" i 6{ f TEL Cog-,)- Cl d— 61/7 7 FAX CELL EMAIL /J a c,,,PG, /74,--v' a 6-1 ., 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