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HomeMy WebLinkAboutBLDP-18-005576 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �s• • CITY YARMOUTH MA DATE 4/6/18 PERMIT# BLDP-18-005576 JOBSITE ADDRESS L OUT OF BOUNDS DR ] OWNER'S NAME BANKS RICHARD W P OWNER ADDRESS BANKS KATHLEEN M 27 OUT OF BOUNDS SOUTH YARMOUTH,MA TEL 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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 m NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY m 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 William Loder LICENSE 70016 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP❑# LLC ❑# COMPANY NAME William B Loder ADDRESS PO BOX 201 CITY SOUTH ORLEANS STATE MA ZIP 026620201 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ DCDMIT FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - --- CITY \14L} e;,6%., 0-- MA DATE CQPt- l 9 PERMIT #B0✓ - SS� JOBSITE ADDRESS 2:2 our- or Av(24 OWNER'S NAME :.CAA.. 12V &I1-1 c OWNER ADDRESS ;^)--? t Au1-105 ,� TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: L2' PLANS SUBMITTED: YES ❑ NO ❑ FIX-'URES 7. FLOOR--+ BSIMI 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/ AREA DRAIN INTERCEPTOR (INTERIOR) 1 KITCHEN SINK LAVATORY 1 I ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET .----CiC° / 7- URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _ WATER PIPING OTHER INSURANCE COVERAGE: l have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES21' NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ci 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 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 Prtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r Ij '_-IJ_II_) PLUMBERS NAME LICENSE # 2064k, . SIGNATURE MP JP id CORPORATION # PARTNERSHIP 0# Lc 0 # COMPANY NAME CAJL.4.AA v h g2 PL.c , 44/2-icl ADDRESS Pt; 60 X Vr CITY O`1 C` eA LIS STATE M ZIP 6 Z f 2-- TEL, u'237 373? 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY'YARMOUTH I MA DATE(April 06,2018 'PERMIT# BLDP-18-005576 JOB;ITE ADDRESS 27 OUT OF BOUNDS DR OWNER'S NAME IBANKS RICHARD W G OWNER ADDRESS BANKS KATHLEEN M 27 OUT OF BOUNDS SOUTH YARMOUTH MA TELI I 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NOD 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© NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certiry that all of the details and information I have submitted or entered regarding this application are hue 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 William Loder LICENSE#20016 SIGNATURE MP❑MGF❑JP© JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: William B Loder ADDRESS PO BOX 201, CITY SOUTH ORLEANS STATE MA ZIP 026620201 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM AS FITTING WORK ,_'L 1�� PERMIT �� !d ~ SS7 , • �._= .,g, CITY y - MA DATE (2 P*1- it JOBSITE ADDRESS 2,-) CL-T ( tP tdat.t% (LA OWNER'S NAME 1' .‘..ctiAliii 9 .+ ç5 GOWNER ADDRESS i o -re, +4.44.4.e s al TEL FAX TYPE OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: n RENOVATION: ❑ REPLACEMENT: V PLANS SUBMITTED: YES ❑ NO APPLIANCES -1 FLOORS--4 2 BSM13 � 5 7 °� 9 10 'I'I 12 '13 14 BOILER BOOSTER ____I CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 1 i FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER - r...:- I LABORATORY COCKS ? MAKEUP AIR UNIT OVEN APR 1'� l' 2�116 I --, i POOL HEATER7 I ROOM ! SPACE HEATER 0 ' ROOF TOP UNIT TEST _ . - V UNIT HEATER UNVENTED ROOM HEATER WATER HEATER V OTHER 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVGL. Ch. 142 YES 'WO ❑ I IF YOU CHECKED YES, PLEASE. INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY il OTHER TYPE INDEMNITY n BOND n OWNER'S INSURANCE V A[VER: I am aware that the licensee does not have the insurance coverage required by Chapter 14.2 of the r Massachusetts General Laws, and that my signature on this permit application waives this requirement.. t. i CHECK ONE ONLY: OWNER ❑ AGENT ❑ . SIGNATURE OF OWNER OR AGENT I 1: 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 I `- and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe 'vent provision of the Massachusetts State Plumbing Code and Chapter -142 of the General Laws. '`I t get/ ��j . /I PLUMBER-GASFITTER NAME LICENSE # 0L, GNATURE MP ❑ MGF ❑ JP V2f JGF n LPGI ❑ CORPORATION ❑ #f PA,KAERSHIP ❑ # LLC ❑ # COMPANY NAME LtJ 4.4,..4cwk Loftin, th,-LAI ..101/4 '`1 ADDRESS Ps A.. 'di_ CITY 6Qt.4›ri A 01..LC 4u 5 STATE i4A4 ZIP O Z(c 62.. TELSZ -237- 3 7Y7 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 t6 PLAN REVIEW NOTES • • j 'i v- uUMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMEN w, PLUMBER � WILLIAM B LODER POBOX201 z SOUTH ORLEANS, MA 02662-0201 z ;W aJ 20016 05/01/2018 • 28874 • CENSE NUMBER EXPIRATION DATE SERIAL NUMBER