Loading...
HomeMy WebLinkAboutBLDP&G-21-006916 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK `m CITY YARMOUTH MA DATE 5/28/21 PERMIT# BLDP-21-006916 JOBSITE ADDRESS 47 WILSON RD OWNER'S NAME CONKLIN ROBERTJ P OWNER ADDRESS CONKLIN SUSAN L 47 WILSON RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW El RENOVATION:El REPLACEMENT:❑' PLANS SUBMITTED: YES❑ 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 at 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 Troy Gilbert LICENSE 18573 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 1es Na THIS APPLICATION SERVE AS THE PERMIT ❑ 111 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,ro vs CITY I South Yarmouth MA DATE 05/25/2021 i PERMIT # _ _ JOBSITE ADDRESS LWilson Road OWNER'S NAME Bob Conklin OWNER ADDRESS same I TEL _FAX TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL I RESIDENTIAL 11 PRINT CLEARLY NEW: RENOVATION: 0 REPLACEMENT: Lj PLANS SUBMITTED: YES NO FIXTURES Z FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB , MIIII INN CROSS CONNECTION DEVICE Iil DEDICATED SPECIAL WASTE SYSTEM i ............... DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ' ! DEDICATED GRAY WATER SYSTEM 7 _ � --fir I DEDICATED WATER RECYCLE SYSTEM r " 111111 { _MN I'. DISHWASHER IIIIIIIIIII - Illin , ME DRINKING FOUNTAIN IMgr hI FOOD DISPOSER �I� i— M_ Tilin.----.------m FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) ��� - , M —111.11M IM KITCHEN SINK MEM IMI -MM. !' IIIIIIIIIIIIIIIIIII IIM LAVATORY ;M nal MMIIIIIII[MMIN ROOF DRAIN SHOWER STALL �� Winain__ SERVICE / MOP SINK OM �� I MI TOILET :1111: 11111air 11 URINAL �- ■9 WASHING MACHINE CONNECTION CIIIII � WATER HEATER ALL TYPES WATER PIPING ICI MIMI i I . OTHER I � ,_ 1 :- r E.. .....-...... _ ___...... INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Li I 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /�— �/J aht- PLUMBER'S NAME Troy Gilbert LICENSE # E13-573 1 SIGNATURE MP i JP CORPORATION # 7 PARTNERSHI P P# LC L l 1#' 4350 COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY South Yarmouth STATE I MA l ZIP L 02664 1 TEL 508-737-8747 FAX i CELL 508-850-6955 1 EMAIL L lisa coastal hc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 16 CITY YARMOUTH MA DATE May 28,2021 PERMIT# BLDP-21-006916 I_f�f° JOBSITE ADDRESS 47 WILSON RD OWNER'S NAME CONKLIN ROBERT J G OWNER ADDRESS CONKLIN SUSAN L 47 WILSON RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisana coastalphc.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ®c4;, •� - • ` � ��, CITY South Yarmouth w ' MA DATE 05/25/2021 PERMIT # F� i JOBSITE ADDRESS 47 Wilson Road OWNER'S NAME Bob Conklin GOWNER ADDRESS TEL 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL RESIDENTIAL 1 PRINT CLEARLY NEW: RENOVATION: l REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER --11-- - .-11 __ _ _. _- BOOSTER CONVERSION BURNER COOK STOVE _ __ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE .. .. _. . t- _ — —:�' INFRARED HEATER - LABORATORY COCKS MAKEUP AIR UNIT _ iii ._ a_., -- —. OVEN POOL HEATERLi, _ ,. ROOM / SPACE HEATER I- µ _ L ROOF TOP UNIT i TEST tr- UNIT HEATER _ ,.. UNVENTED ROOM HEATER F _ WATER HEATER f 1 OTHER y,.�....... .. .., �..._ ... w. ..ea.,, .,, u,...,M,.,_ .. ._,. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITY FA 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 D 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �-- l2,7 ,I.a PLUMBER-GASFITTER NAME Troy Gilbert LICENSE # 13573 SIGNATURE MP i MGF JP JGF ® LPGI CORPORATION ,# PARTNERSHIP # LLC i # 4350 COMPANY NAME: Coastal Mechanical ADDRESS 21 L Fruean Ave CITY South Yarmouth _ 1 STATE MA } I ZIP. 02664 TEL [508-737-8747 FAX CELL 508-850-69551EMAIL[Ia©coasta1phc .com