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HomeMy WebLinkAboutBLDP&G-21-006674 G MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMB DP WORK 0R674 k,,,, MA DATE PERMIT CITY YARMOUTH OWNER'S NAME DANIELSON NANCY M(LIFE EST) l ii jP JOBSITE ADDRESS 26 COUNTRY CLUB DR TEL r�� P OWNER ADDRESS DANIELSON RONALD&LINNEA S TR 26 COUNTRY CLUB DR SOUTH YARMOUTH,MA 02664 RESIDENTIAL ❑ COMMERCIAL ❑ NO TYPE OR OCCUPANCY TYPE PLANS SUBMITTED: YES❑ PRINT RENOVATION:0 REPLACEMENT: 6 00 9 10 11 12 ® 14 CLEARLY NEW. ❑ �0©© FIXTURES FLOORS ____-_-___--__ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM __=== = = IIIII DEDICATED GAS/OIL/SAND SYSTEM -_ _______ ___ DEDICATED GREASE SYSTEM ______-___ DEDICATED GRAY WATER SYSTEM - __ _____ DEDICATED WATER RECYCLE SYSTE --_===__-___=== DISHWASHER ===_______==___ DRINKING FOUNTAIN __________ FOOD DISPOSER ____-- ===_-_ MIIIIIII FLOOR I AREA DRAIN _-_ _iiiiiiiii111111 R(INTERIOR) ______ __=====_ 111111 LAVATORY - ___ ___________ IIIIIIIIIII ROOF DRAIN __--__--_ ____ SHOWER STALL _______ _ ___= SERVICE/MOP SINK ---------==--- TOILET __--____=___=== URINAL __WATER 1-111111111111111111111111111111111111111111111111111 _- IIIIII WASHING MACHINE CONNECTION _=====_ ___ OTHER -__- OTHER DESCRIPTION: INSURANCE COVERAGE: YES El NO ElI have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW CI BOND CI INSURANCE POLICY[D OTHER TYPE OF INDEMNITY OWNER 'S INSURANCE WAIVER:I am aware that the licensee doesVeheinsurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives thisrequirement. SIGNATURE OF OWNER OR AGENT 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 I hereby performed under the permit issued for this application will be in compliance with all Pertinent provision of the ll plumbing work and installations Massachusetts State Plumbing Code and Chapter 142 of the General Laws. SIGNATURE LICENS:9015 PLUMBERS NAME Albert Cassano PARTNERSHIP CI# � LLC 0# MP 0 JP 0 CORPORATION ❑# ADDRESS 8 Fruean Way COMPANY NAME Cape Cod Mechanical Systems,Inc. TEL 5083947501 CITY South Yarmouth STATE IEIIIIIIIIIIIIIIII ZIP 02664 FAX CELL 5087769536 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES THIS APPLICATION SERVE AS THE PERMIT D El No FEES$ PERMIT# PLAN REVIEW NOTES _T• r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK fi-(.: 7limirti, CITY YARMOUTH MA DATE May 18, 2021 PERMIT# BLDP-21-006674 7'-3•,-:i ..__c ;y "" JOBSITE ADDRESS 26 COUNTRY CLUB DR OWNER'S NAME DANIELSON NANCY M (LIFE EST) G OWNER ADDRESS DANIELSON RONALD & LINNEA S TR 26 COUNTRY CLUB DR SOUTH YARMOUTH TEL MA 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 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 1 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 0 NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 Albert Cassano LICENSE # 9015 SIGNATURE MP El MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: Cape Cod Mechanical Systems, Inc. ADDRESS. 8 Fruean Way. CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX CELL 5087769536 EMAIL 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