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HomeMy WebLinkAboutBLDP&G-21-006939 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i, ,; CITY LARMOUTH ] MA DATE 6/1/21 PERMIT# BLDP-21-006939 k ,,,,' JOBSITE ADDRESS 31 LONGFELLOW DR OWNER'S NAME ELLIOTT B KENT P OWNER ADDRESS PO BOX 249 YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ 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 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 El 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 Leon Hall LICENSE$782 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME LEON R HALL ADDRESS 77 Hazel Ln CITY Brewster STATE MA ZIP 026311729 TEL FAX CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT � ❑ FEES$ PERMIT PLAN REVIEW NOTES • MASSACHUSETTS UNI ORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK = _ CITY IIZ.Mt'� l-Ic __11__ MA DATE PERMIT# JOBSITE ADDRESS ,3 l LQ %1 F i7J Q(Ai Ti - OWNER'S NAME 4V •-a Orr POWNER ADDRESS SA-Pit - TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:32k PLANS SUBMITTED: YES El NO❑ FIXTURES 7 FLOOR-i BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ' FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN _ SHOWER STALL SERVICE/MOP SINK . TOILET 1 I URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / . WATER PIPING OTHER i INSURANCE COVERAGE: I. 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 LABILITY INSURANCE POUCY ❑ OTHER TYPE OF INDEMNITY 0 BOND ❑ • OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the i' Massachusetts ene I Laws, /at my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER NrAGENT El SIGNATURE OF OWNER OR AGENT L',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 complianc 'th a 'ne ision of the Massachusetts State Plumbing Code and / Chaptera�ndl � LICENSE# ��� .142 of the General Laws. PLUMBER'S NAME '? A �'�`l/F4 / L SIGNATURE MP' JP❑ CORPORATION ❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ADDRESS 77 c �E� '-'' CITY /J� .-cAl57" STATE //A ZIP O9t9J / TEL 5DS W6 °.00:5- FAX CELL EMAIL 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 t\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 01,2021 PERMIT# BLDP-21-006939 JOBSITE ADDRESS 31 LONGFELLOW DR OWNER'S NAME ELLIOTT B KENT G OWNER ADDRESS PO BOX 249 YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ 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 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 Leon Hall LICENSE# 8782 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: LEON R HALL ADDRESS. 77 Hazel Ln, CITY Brewster STATE MA ZIP 026311729 TEL FAX CELL EMAIL none 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 MASSACHUSETTS IFORNI APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK iosf CITY'Val RAoJJT(-1 d "r MA DATE PERMIT JOBSITE ADDRESS 3t Loki 'FEU.o•4J -'`K OWNERS NAME -k • eu_i cm— OWNER OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW;❑ RENOVATION: 0 REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES- FLOORS 55M 1 2 3 1 5 6 7 3 9 10 11 12 iS j4 BOILER BOOSTER CONVERSION BURNER COOK STOVE J i DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE —J GENERATOR —J GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN 1 I ! POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST ....-- •- -•- -• --- UNIT HEATER INVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.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 ❑ OWNERS INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts,Ge r aws,a - m s' nature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Kt" 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�ert�vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME /2i/-(9'l LICENSE# ,b22?" SIGNATURE MP,®" MGF❑ JP ❑ JGF❑ LPG'❑ CORPORATION❑#i PARTNERSHIP❑# LLC❑# COMPANY NAME ADDRESS 77/ , - 'L CITY � � STATE /77 P ZIP (-59Co✓ TEL FAX CELL EMAIL 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