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HomeMy WebLinkAboutBLDP&G-21-006998 r � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/3/21 PERMIT# BLDP-21-006998 JOBSITE ADDRESS 85 LONGFELLOW DR OWNERS NAME CLARK ROBERT W TRS P OWNER ADDRESS CLARK MAUREEN TRS 85 LONGFELLOW DR YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL al PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 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❑ 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. PLUMBERS NAME Andrew Leighton LICENSE E6130 SIGNATURE MP 0 JP 0 CORPORATION ❑# 1 PARTNERSHIP ❑tt LLC ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.com 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 gc CC? S: , _,• 1 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �l MA DATE: i PERMIT# (u.0 P 2( W(o�iY 1 XAR/(---,04:`, ., ;� �,ti O S NAME; C' i%,t'� � ?'`> _ JOBSITE ADDRESS A ya(i~ (7- ) t p -�: � �. �FAX i OWNER ADDRESS C,' J, TYPE OR OCCUPANCY TYPE COMMERCIAL_ EDUCATIONAL, RESIDENTIAL-7( PRINT PLANS SUBMITTED: YES NO CLEARLY NEW: � RENOVA T ION: y REPLACEMENT: tf Ti t FIXTURES I FLOOR-. ! sscii ` 1 ' 25 9 i 3 1 4 I 6 ' 7 8i 10 1 1; 1 12 13 1� - '. � ._. .____ . .. __--_ lifitsisrulitamic CROSS CQNd11EC7ON DEVICE � _ _._ __..._ _ _ . D �___..._....... DEDICATED SPECIAL WASTE E SYSTEM - _---- _ � _- -- DEDICATED ED GAS/OIL/SAND SYSTEM s.__._ . DEDICATED GREASE SYSTEM __ _ = ___ -' - ; DEDICATED GRAY WATERSYSTEM ___j ___. r WATERDEDICATED RECYCLE SYSTEM -DISHWASHER : WYLINIF KINKING FOUNTAIN _ . FOOD DISPOSER —_- __— --- -- - -- -_=- ---_---_ FLOOR I AREA DRAIN __- - - INTERGEP 0R oN'TERIOR} .. _ ._._ ------- - _ - - - - LAVATORY ' .:._ ROOF DRAIN I -- ': imilw STALL - _ SHOWER :._._._ -_ _ —. - _-- - _ - —II —II 101111101- SERVICE 1 MOP SINK � _V_._._.......__..._._.::__----Y...-._. .. . ._ 1.-- --- -- — - - - - TOILET URINAL _._. __ _ .__ _ • MINE CONNECTION WASHING MACHINE - M W_ = WATERHEATER ALL TYPES_S _ _. - _ ; : _ =:__ WATER PILING � � ` OTHER _ - __ _ - - -;_----_— _" _` . _ �_ __ _______ INSURANCE COVERAGE: - equivalent which� requirements of�tCt Ch.'I42 YES� NO .,_ I have a current I'a�x� .ir��trar�ce policy or its substantial YOU CHECKED IF YES, PLEASE INDICATE .THE TYPE OF COVERAGE BY CHECKING:I'HE APPROPRIATE BOX BELOW iABILiTY INSURANCE POLICY ; 0 ?-HER TYPE OF INDEMNITY _ z BOND �_ �f OWNERS WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter'Id the INSURANCELaws,and that my signature on this permit application waives this �� Massachusetts Genera! �' i CHECK ONE ONLY: 0 ER _. AGENT SIGNATURE LIRE OF OWNER OR AGENT - u - ` ' -� _ ►kn�v pp�.��Y., true 1- . ; .�. that all of the deta�Zs and irrFcon I have submittedor entered applicationthis tinri�I -- in�np =,�ce with =���", . • --ion of th Idrha �Y under the permit issued and that all pi�zsrtbmg work and installations performed • t-- tlrtzssa:.F3i3setLs Staff Plumbing Code and Chap#er'i42 Cr 2 General Laws- - /, - _,r -- PLUMBER'S �aNDREW LEICHTON -� LICENSE# < 'I613Q-I<tI '� ` GNA'i LIRE ,- T <: SHIP ` LLC _ ! — CORPORATION'„J 3734C_ _SPAR T NER �., ;.. .1=— _ -o_ ` DRESS RT 'I 34 HALL OIL COMPANY INC.INC______ COMPANY NAIEVIE'_ 1TCIY SOU DENNIS - STATE - MA 1 LP 1 02fi 3 TEL 1 . �. PLY 1 n�..1 =5 68 1 Cam- Lh ak�.pri� . ' 1 �B~ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1/40 CITY YARMOUTH MA DATE June 03,2021 PERMIT# BLDP-21-006998 JOBSITE ADDRESS 85 LONGFELLOW DR OWNERS NAME CLARK ROBERT W TRS G OWNER ADDRESS CLARK MAUREEN TRS 85 LONGFELLOW DR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 12 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 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 I 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 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 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 (Andrew Leighton I LICENSE# 16130 SIGNATURE MP©MGF 0 JP 0 JGF❑ LPGI❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'ANDREW R LEIGHTON I ADDRESS. 20 Brewster Rd, CITY IW Yarmouth I STATE MA ZIP 026735706 TEL I FAX I I CELL I I EMAIL Ihalloilcampany(adgmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El E FEE: $ PERMIT # PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY /✓/Yh'+r-/&-i// MA DATE /�7 PERMIT jSt oG'u oo° S JOBSITEADDRESS gS Gl•�m�yfCllocx: _Dr -OWNER'S NAME 3©) Ctank OWNERADDRES5 r' TELsoa-,480--000 FAX TYPE OR OCCUPANCY TYPE PRINT COMMERCIAL EDUCATSONAL RESIDENTIAL dd CLEARLY NEW: RENOVATION: REPLACEMENT:t/ PLANS SUBMITTED:YES NO Y APPLIANCES 1 FLOORS-. 13951 1 1 2 1 3 4 5 6 7 8 9 10 11 12 I 13 1 BOILER BOOSTER _ r _ CONVERSION BURNER _ I 1 COOK STOVE - I I DIRECT VENT HEATER DRYER I FIREPLACE I . I FRYOLATOR FURNACE • 1 I I i I GENERATOR - . . GRILLE INFRARED HEATER - LABORATORYCOCKS - -— - - - - - - MAKEUP AIR UNIT -' - - OVEN 1 - -- POOL HEATER . .I - • 1 ROOM!SPACE HEATER . 1 I . __ ROOF TOP UNIT TEST . - I __ UNIT HEATER 1 - . - i . I UNVENTED ROOM HEATER I - I I I I WATER HEATER • �c - , .1 1 OTHER 1 . I - . i I I I - I I I I I I INSURANCE COVERA.- I have a current liability insurance policy or its substantial equivalent which meets the requirements of BILL Ch.142 YES_t NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE PPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY if/ OTHER TYP a INDEMNITY BOND- OWNER'S INSURANCE WAIVER:I am aware that the lIcensee does not have the i - ranee coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application wai this requirement CHECK ONE O : OWNER AGENT SIGNATURE OF OWNER OR AGENT - r I hereby certify that a0 of the detaas and infbrtneon I have submitted or entered reoe:eins•' ennuocson ere a end a �b a my know tg and that all plumnind wade and[nsraneaona performed m under e pears Issued for this appli.:'.n will be In Allan II PA "on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, PLUMBER-GASFDTTER NAME ANDREW LEIGHTON LICENSE 16130.M SIGNATURE MP + MGF JP JGF LPG! CORPORATION +4 3734C PARTNERSHIP # LLC tc COMPANY NAME HALL OIL COMPANY INC. ADDRESS 435 RT I CITY SOUTH DENNIS STATE MA ZIP n•:+.0 TEL 508 398-383f FAX 508-394-3088 CELL eitAIL hallokompany@gmail.com