Loading...
HomeMy WebLinkAboutBLDP&G-22-004180 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yr, _/ CITY YARMOUTH MA DATE 1/26/22 PERMIT BLDP-22-004180 JOBSITE ADDRESS 2 SACHEM PATH OWNER'S NAME REGINA OKEEFE P OWNER ADDRESS 2 SACHEM PATH WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ 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/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❑ 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 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 wit be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Lows. PLUMBER'S NAME Michael Mcbride LICENSE 119681 SIGNATURE MP El JP El 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$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R f ` 1 Vi I1 MA DATE Z ?5— z ZPERMIT# 2 `t Y u JOBSI 'DRESS 7 Cz G Pct.. 0 ER'S NAME 0Qy l•` A 0 it ', t; 'U�wNE 'I DRESS !I giL1/1 3(.^ SI0 r , n5r LAL� ,/5 )yZ7- 2Y ' FAX =6 t-O _` " de6b AN, Y TYPE' - COMMERCIAL r] EDUCATIONAL CI RESIDENTIAL E " PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: l_. PLANS SUBMITTED: YES❑ NO Et 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM 1 • DEDICATED GRAY WATER SYSTEM 1 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 URINAL WASHING MACHINE CONNECTION 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 E NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 LI-I 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. � ..c l PLUMBER'S NAME LICENSE# (-IG�7 ( SIGNATURE MP❑ JP rn CORPORATION 0# PARTNERSHIP❑.# � l LLC❑# 0 re 1" COMPAN �� 3>) NAME r t L2 , 1-1 4- ADDRESS , ) 7 77 n v'/7'1 t4I`) L/f CITY (fAl r\ f\I S STATE M ZIP 0 Z () / TEL I // �7 ) 7/Z�, FAX CELL EMAIL S n� I'•J1 rib r, 11-to Q ykyi L. law, 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 CITY YARMOUTH MA DATE January 26,2022 PERMIT# BLDP-22-004180 1; `5. JOBSITE ADDRESS 2 SACHEM PATH OWNER'S NAME REGINA OKEEFE G OWNER ADDRESS 2 SACHEM PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:LI 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(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 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 (Michael Mcbride LICENSE# 19681 SIGNATURE MP 0 MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IMICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinper.mcbride(a gmail.com S31ON M9IA321 NVld #1.J1A1?33d $ :33d 11110:13d 3H1 SV S3AH3S NOI1d01lddd SIH1 oN seA S310N NOI103dSNI 1VNId AlNO 3Sf1 f0103dSNI 21Od 39Vd SIH1 S310N NOI103dSNI SVO H9flO SSACHLISETTS UNIFORM APPLICATION FOR PE qpiviT PERMIT TO PERFORM GAS FITTING WORK '-'.-- 'IVA-E.Fir=1" y�sw, C� cJ MA DATE PERMIT Z `'l ( y J A N - 2 6 20 30B IT ADDRESS P St-L%--12--LA--,i�i Gt � 0 �`cR'� hJ. ,ME"' BULLD1ly CPAF --r 'NEf? DDRESS `j U � rr n �- f - YFA E PRE, OCCUPANCY TYPE COMMERCIAL ❑v EDUCATIONAL ❑ RESIDENTIAL ❑ CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: c PLANSSUBMITTED: YES = NO Z. APPLIANCES 1 FLOORS-+ BSM 1 BOILER 5 6 7 9 1 11 i 13 1�� BOOSTER CONVERSION BURNER COOK STOVE --, 1 l DIRECT VENT HEATER DRYER, I FIREPLACE ----- FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ► a MAKEUP AIR UNIT I . OVEN j POOL HEATER ROOM ! SPACE HEATER ROOF TOP UNIT TEST . UNIT HEATER • - •-• • •• - - • ---- - -- . . = Uh�EVE(dTED ROOM HEATER WATER HEATER / OTHER —y I 1 _ I 1 INSURANCE COVERAGE I I have a current Iial insurance policy or its substantial equivalent which meets the requirements of � NIGL. Ch, 142 YES, ❑ NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND • licensee does not have the insurance INSURANCE WAIVER: I amaware thaf the IicP ❑ 1 .. at-irancP coverage requiredby Chapter 142 of the1 Massachusetts General Laws, and that my signature on this permit application waives this • i et�uirEment, SIGNATURE OF OWNER OR, AGENT =� CHECK ONE ONLY: OWNER ❑ AGENT [I` � have submitted or I hereby certify that all of the details and information I 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 Massachusetts State Plumbing Code and Chapter .142 of the 9 ig,_ will be in compliance with all Pertinent pro�rision oTtl►egp general Laws.PLUMBER-GASFITTER NAME LICENSE # SIGNATURE MGF E JP [ JGF ❑ LPGI ❑ CORPORATION Ill Illp +rO P PARTNERSHIP #COMPANY I AME J� ❑ LLC ❑ # t. ADDRESS rair`3 / L ( ' --) A-4. -e. CITY O STATElig ZIP 2_& c TEL 77Cj , Z2-- FAX CELL j EMAIL '7—j . y -e-/. , OUGH GAS SFE NpTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • •