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HomeMy WebLinkAboutBLDP&G-21-005944 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ir. , CITY YARMOUTH MA DATE 4/14/21 PERMIT# BLDP-21-005944 --_t_I JOBSITE ADDRESS 379 WEIR RD OWNER'S NAME KARRAS STEVEN J TRS P OWNER ADDRESS KARRAS CHERYL A TRS 379 WEIR RD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO El FIXTURES 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING 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 El 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 will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Ronald Nurse LICENSE f6397 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD W NURSE ADDRESS 221 COTUIT RD CITY SANDWICH STATE MA ZIP 025632655 TEL FAX CELL EMAIL ptech88@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES -,21130 [ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ___j=�� CITY c tv"��a�C� MA DATE Li -' l.� -�-L%,1-l PERMIT#a CD P-.2"(-GO S-q ci i JOBSITE ADDRESS 3 k---=el v �c;l OWNER'S NAME V.-4.1v-rc.‘ POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:fl REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ - 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/OIUSAND SYSTEM _ . DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM . DEDICATED WATER RECYCLE SYSTEM . DISHWASHER k DRINKING FOUNTAIN FOOD DISPOSER FLOOR i AREA DRAIN _ INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY i i _ . ROOF DRAIN _ _ SHOWER STALL SERVICE/MOP SINK _ . TOILET i I 1 - URINAL WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES WATER PIPING 1 _ OTHER _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES VI NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY (:f 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance33Cth Pertinent pro ' on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - -� I �1 I. PLUMBER'S NAME .,^ j��F LICENSE# )$j6/7 '✓ SIGNATURE MP JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME f V�v,mob ...i, \-CA_ Og� ADDRESS �� . 0 l�J►�v vas y-� CITY a,-N :1 tii i C� J STATE 1✓'A ZIP C' _.)_5(, -3 TEL .10 6.- O— '-[c.7< 4 FAX CELL EMAIL S NY' c Ls• gF as ..art'a . Cc''''A 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 k--M,''. CITY YARMOUTH MA DATE April 14, 2021 PERMIT# BLDG-21-005945 :ice, �' JOBSITE ADDRESS 379 WEIR RD OWNER'S NAME KARRAS STEVEN J TRS G OWNER ADDRESS KARRAS CHERYL A TRS 379 WEIR RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 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 /SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER 1 UNVENTED ROOM HEATER WATER HEATER _ 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 Ronald Nurse LICENSE # 13397 SIGNATURE MP © MGF ❑ JP ❑ JGF ❑ LPG' ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: RONALD W NURSE ADDRESS. ,221 COTUIT RD, CITY SANDWICH STATE MA ZIP 025632655 TEL FAX CELL EMAIL ptech88 aRgmail.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 -46a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7 CITY: 8 0.v- w".QvA\`--N MA. DATE: I-( " I.1' t: ) PERMIT#4i_I)v-11 -0°59`i I- JOBSITE ADDRESS: - 7ck U Pam\r Z k OWNER'S NAME: /c.vv o—5 GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ril PRINT CLEARLY NEW:0 RENOVATION:[2 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES-. FLOOR-0 Bsmt 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 VI INFRARED HEATER W _LABORATORY COCK _ MAKEUP AIR UNIT ' OVEN POOL HEATER ROOM/SPACE HEATER J ROOF TOP UNIT . fi TEST I UNIT HEATER j i- i,u UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES K1 NO ❑ If you have cnecked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF 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 and that all plumbing work and installations performed under the permit issued for this application will be krainlpiance withal P • ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: v\ %'4i.cJ r (-) LICENSE# /;33C/7 SIGNATU COMPANY NAME: --C\ti i L..,A4: J l VC-U V' ' Q CI�1 ADDRESS: '� G i JJ Lvk-a cn5 r`.J Cl::)._ CITY: ..•-t_,-,_crt L. J t c .- STATE: w iA ZIP: 0.CSC, 3 FAX: TEL: Sc'6'f-aP3O tlo G`(CELL: EMAIL: F -AA.86 6x 5,4-,_ca , \ , c n ,''— MASTER❑ JOURNEYMAN 0 LP INSTALLER 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# C /Y)/, G S ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMITS PLAN REVIEW NOTES