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HomeMy WebLinkAboutBLDP&G-22-004267 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/31/22 PERMIT# BLDP-22-004267 JOBSITE ADDRESS 37 ACRES AVE OWNER'S NAME BARGSLEY LISA P OWNER ADDRESS 12002 BLACK ANGUS RD AUSTIN,TX 78727 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT© PLANS SUBMITTED: YES❑ NO 0 FIXTURFS 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/OIUSAND 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 0 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❑ 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 allot 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 Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Troy Gilbert LICENSE 16573 SIGNATURE MP 0 JP 0 CORPORATION ❑# L PARTNERSHIP ❑# LLC ❑#[ COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lira@coastalphc.com • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El El FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK s� .�s�'V s` 1°' 9 CITY Yarmouth MA DATE 1 /27/2022 PERMIT# • 11---`1 Z(.. ) JOBSITE ADDRESS 37 Acres Ave West Yarmouth, MA 02673 OWNER'S NAME Don Dudley OWNER ADDRESS 37 Acres Ave West Yarmouth, MA 02673 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: (l RENOVATION: ❑ REPLACEMENT: I PLANS SUBMITTED: YES El NO ❑ FIXTURES 7 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 1 AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK , LAVATORY ROOF DRAIN _ SHOWER STALL SERVICE /MOP SINK TOILET URINAL 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 [j NO ❑ 1F YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. /l/&ice CHECK ONE ONLY: OWNER 2 AGENT ❑ SIGN RE 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7-f,, g f,- PLUMBER'S NAME LICENSE# 13573 SIGNATURE MP JP ❑ CORPORATION 0 # 4350 PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Way CITY Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX CELL EMAIL Katherine@Coastalphc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY:Yarmouth MA. DATE:1/2712022 PERMIT# ZZ—41,0 JOBSITE ADDRESS 37 Acres Ave West Yarmouth,MA 02673 OWNER'S NAME: Don Dudley GOWNER ADDRESS: 37 Acres Ave West Yarmouth,MA 02673 TEL: FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL Ev7 PRINT CLEARLY NEW❑ RENOVATION:0 REPLACEMENT:d PLANS SUBMITTED:YES❑ NO❑ APPLIANCES? FLOOR—. Beret 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 1n INFRARED HEATER t31 LABORATORY COCK kMAKEUP AIR UNIT OVEN POOL HEATER ROOM!SPACE HEATER J ROOF TOP UNIT CZ TEST Z UNIT HEATER tq J UNVENTED ROOM HEATER WATER HEATER V INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES El NO 0 Ityou have checked Y.please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY EJf 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. /v% CHECK ONE ONLY: OWNER 12( AGENT❑ SIGNATUR OWNER OR AGENT 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 end that all plumbing work and installations performed under the permit issued for rids application will be In compliance with e I Pertinent provision of the Massachusetts State,Plumbing Code and Chapter 142 of the General Laws. �` _ /2B todit PLUMBER/GASFITTERNAME: Troy Gilbert LICENSE# 13573 or fl1RE COMPANY NAME: Coastal Mechanical ADDRESS: 21L Fruean Way CITY: Yarmouth STATE: MA ZIP. 02664 FAX: TEL: 508-737-8747 CELL: EMAJL: Katherine@Coastalphc.com MASTER Er JOURNEYMAN❑ LP INSTALLER❑ CORPORATION[vr# 4350 PARTNERSHIP 0# LLC 0# Emn/c. ADLtee-ss: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .p. CITY YARMOUTH I MA DATE January 31,2022 PERMIT# BLDP-22-004267 JOBSITE ADDRESS 37 ACRES AVE OWNER'S NAME BARGSLEY LISA G OWNER ADDRESS 12002 BLACK ANGUS RD AUSTIN TX 78727 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 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 requiremeit. 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX 7 CELL EMAIL lisa a(�ccastalphc.com S310N M3IA3b NVId #LI1,1213d $:33d 1111213d 3H1 SV S3A213S NOIiVOIlddV SIHl oN s9A S310N NO1103dSNI 1VNH AINO 3Sfl a0133dSNI 210d 3OVd SIR! S31ON NO1103dSNI SVO HOflO J