Loading...
HomeMy WebLinkAboutBLDP&G-22-001505 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/16/21 PERMIT# BLDP-22-001505 II JOBSITE ADDRESS 61 KEEL CAPE DR OWNER'S NAME BISHOP LINDA A P OWNER ADDRESS 61 KEEL CAPE DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO❑ FIXTURFS z FLOORS-- BSM 1 2 3 4 f 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ 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 James Oconnor LICENSE 132989 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JAMES OCONNOR ADDRESS 117 GREAT MARSH RD CITY CENTERVILLE STATE MA ZIP 026322413 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT PLAN REVIEW NOTES • J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ; l III i. C D, -1(rr 5:G;Jtk MA DATE i ' 2.—1 PERMIT# ? -- !roc 6 S 7 1 5 2O22TBS i E DDRESS c i KkeI i]f OWNER'S NAME K:pi e, • i .__ ilib � FAX W_ DRESS TEL I. Lii� wl uE ri1 { MEN i ` -T eR OCC CY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL V PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:V PLANS SUBMITTED: YES ❑ NO V 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 I TOILET i URINAL /` WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING OTHER 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 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. 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 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. ( - 0 '(/ __--• PLUMBER'S NAME LICENSE# 1298'1 • G SIGNATURE MP Vf JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC`�I# COMPANY NAME S ire! GCc nno( ;'1,,,.,J 6 i_11-, ADDRESS !17 Grcc t fl1t- IQ� CITY Cen-ick,Jk STATE ✓'A 0 ZIP QZ637 TEL 77V 3 S3 F3aL FAX CELL EMAIL Jim cx.,nnptp(..,..b.•1 v.:1 •con) --7 7 L/ 3 53 83 62 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ( I FEE: $ PERMIT # PLAN REVIEW NOTES • I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY YARMOUTH MA DATE September 16,202 PERMIT# BLDP-22-001505 f _II- JOBSITE ADDRESS 61 KEEL CAPE DR OWNER'S NAME BISHOP LINDA A G OWNER ADDRESS 61 KEEL CAPE DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 ❑ 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 James Oconnor LICENSE# 12989 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: JAMES OCONNOR ADDRESS. 117 GREAT MARSH RD, CITY CENTERVILLE STATE MA ZIP 026322413 TEL FAX CELL EMAIL S310N M31A3LI NVId #11WI3d $:33d ❑ ❑ 11InN3d 3H1 SV S3A2i3S NOI1VOIlddV SIH1 oN SA S310N N01103dSNI 1VNld AlN0 3Sfl 210103dSNl`JOd 30Vd SIH1 S310N NOI133dSNl SVO HOl0H _'.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK iii_ j ,=_,_ ;.k.—::::. '. 'r Njy �'� rierwLiik MA DATE (; /5 2 i PERMIT # 27_ — l c vC 1 5 20SITE A DRESS CI /eti C.t.pc Dr. OWNER'S NAME K 'pe y . ._. OWNd A DRESS TEL FAX ;1j�.,� k(6 rPARIMENT 3y -f U.TPNY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT': V PLANS SUBMITTED: YES 0 NO1i2 APPLIANCES FLOORS-4 BSlvl 1 2 3 11 5 6 7 8 9 10 11 12 1 I� 1 BOILER r BOOSTER _I CONVERSION BURNER COOK STOVE , DIRECT VENT HEATER I 1 DRYER, ' FIREPLACE FRYOLATOR FURNACE GENERATOR J GRILLE I INFRARED HEATER I LABORATORY COCKS I MAKEUP AIR UNIT I OVEN POOL HEATER • 1 ROOM ( SPACE HEATER ROOF TOP UNIT TEST . _ ....... ._ _._ - . _-.._ 1---_ UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER V OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IMGL. Ch. 142 YES NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY ❑ BOND ❑ I I • OWNER'S INSURAI4CE 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. I i • CHECK ONE ONLY: OWNER l AGENT ❑ SIGNATURE OF OWNER OR AGENT .t�, 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. LII Oister-i) PLUMBE -GASFITTER NAME LICENSE # I Z SIGNA URE MP I MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLCV' COMPANY NAME J WI [7Gon,^<.,r eI,,.,5 E-4-1-,f3 ADDRESS f 7 �r vc4 11 rsk PJ CITY Cc" 4 erii, 1 lr STATE Ai ZIP c)Z6.31_ TEL 77`-/ 3513 A—; ‘) -1-- FAX CELL EMAIL ,In4 e:oiiirpi Lainhir5Ca cA0.. I '<C/^ 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