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HomeMy WebLinkAboutBLDP&G-23-002347 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/31/22 PERMIT# BLDP-23-002347 JOBSITE ADDRESS 27 LEWIS BAY RD OWNER'S NAME ASHMORE ALICE F P OWNER ADDRESS ASHMORE THOMAS 27 LEWIS BAY RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURFS FLOORS RSM 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❑ 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❑ 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 Michael Mcbride LICENSE'16681 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMIT# PLAN REVIEW NOTES I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _,ik- CITYN(7•l i MA DATE PERMIT# Z 3 2} ci I 2 8 m171 ADP' RESS Z7C w /l J igf'71G%4/G OWNERS NAM E7)/� 4/ /1 IftW/ BUI. P OWNER'AD RESS 5'TTEL 7 71 ! fY FAX y 1R i ; OR- OCCUP_ANcY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CI PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:[ PLANS SUBMITTED: YES❑ NO 0 FIXTURES Z 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 I _ _ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK r-- LAVATORY ROOF DRAIN SHOWER STALL �' SERVICE/MOP SINK TOILET _ URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i 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 E NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY I. 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT Ll 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 fort is application will be in compliance with all Pertinent provision of the Massachusetts Sta:e Plumbing Code and Chapter 142 of the General Laws. 0 7 (3- / \ ` PLUMBERS NAME Yv,c/J(' � 1 O � - LICENSE#fro \ SIGNATURE PMP ❑ JP q CORPORATION ❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME l d( (3 r O�.Q 21Q ADDRESS 37 �l cj n t-1,7 f `�/�'iy(/e CITY G( /] 1 / STATEYV4- ZIP Z(O d / TEL 77 Y 7-to 7, zZ FAX CELL EMAIL S I--t/15-ex►M C/3 n cli, 41 3.-1"`A-r,'6„. 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 1^Ii'� CITY YARMOUTH MA DATE October 31,2022 PERMIT# BLDP-23-002347 JOBSITE ADDRESS 27 LEWIS BAY RD OWNER'S NAME ASHMORE ALICE F G OWNER ADDRESS ASHMORE THOMAS 27 LEWIS BAY RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW ❑ RENOVATION:❑ REPLACEMENT:0 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 Michael Mcbride L'CENSE# 19681 SIGNATURE MP❑ MGF ❑ JP❑ ,JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinoer.mcbrideangmail.com 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 •Z N 'ii) . �.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING x--- !i =- WORK .. Il A DATE PERMIT ? 3— �� < JOBSITE ADD ESS V £ A_.J/ 3 OWNER'S i 1 l- J�►�D NAME . y,�J , s---0 7- EL 77/'- Yx FAX PE TY ' ufttP5 twiT yrE COMMERCIAL (l ED CAT IONAL I 1 RESIDENTIAL CLEA ,Y NEW: 1- ENOVATION: 0 RE,LACEMENT: I)el PLANS SUBMITTED: YES � NO APPLIANCES _I FLOORS--. B`IO 1 ? 5 1 5 6 7 BOILER — y 10 11 12 13 14 , BOOSTER CONVERSION BURNER COOK STOVE . DIRECT VENT HEATER ' DRYER, - FIREPLACE FRYOLATOR l _ _ FURNACE GENERATOR, GRILLE I r_____11 INFRARED HEATER LABORATORY COCKS -- MAKEUP AIR UNIT OVEN . , POOL HEATER ROOM l SPACE HEATER � . ROOF TOP UNIT TEST — , UNIT HEATER UNVENTED ROOM HEATER WATER HEJt\TER / OTHER . 1 INSURANCE COVERAGE I have a current Ieabili insurance policy or its substantial equivalent which meets the requirements of F GL. Ch. 142 YES S — � NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIAEILITY INSURANCE POLICY IWf OTHER TYPE INDEMNITY 1 BOND (— OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b Chapter 142.Massachusetts General Laws, and that mysignature on this permit application waives- this requirement. Y of the SIGNATURE OF OWNER OP, AGENT CHECKONE ONLY: OWNER _ AGENT ``�- I hereby certify that all of the details and information I have submitted or entered regarding this application are ` - and that all plumbing work and installations performed under the permit issued for this application will ben com trul ane accurate to the best of my knowledge �• Massachusetts State Plumbing Code and Chapter -I42 of the Gene'al Laws. 5 1,,, 7 p lanc e with all Pertinent provision of the / LZ PLUMBER-GASFIT [-ER, NAMEMI # SZ- `l , i G ..� 4 LI �� LICENSESIGNATU RE MP I , MGF [i JP [; . JGF LPGI CORPORATION r [ 1 n F PARTNERSHIP �r LLC n v COMPANY NAME ADDRESS n7 CITY n C STATE A4- ZIP 6 1p C / FAX TEL CELL EMAIL • I I I G. W 0 4 0 I Pi 1 C1 i W I 1 1 1 I i i �a �0 I 1 Gr1 F E" a. 0 1 a, I— a ri i U' < el, • - 14 ill > uI <C W CD W i 0 U Ir a. < ,bp.. up 11.E I S Lu I— 1.1 I 1 Cf W 0 I 7 C) 11 ['"°11 1 (d I WbC I Cf] 1 lJ 1 CU ret I I 1