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Home My WebLink AboutBLDP&G-21-006599 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ziff; CITY YARMOUTH MA DATE 5/14/21 PERMIT# BLDP-21-006599 1i_ JOBSITE ADDRESS 34 WILD HUNTER RD OWNER'S NAME POWERS KEVIN D P OWNER ADDRESS POWERS JULIETTE C 34 WILD HUNTER 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 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. PLUMBER'S NAME Michael Mcbride LICENSE t9681 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 J TEL FAX CELL EMAIL stinger.mcbride@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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Z ` CITY �ZGi /1I �//MBA DATE � � L- / PEW+AIT# Dr!.b�Z( JOBSITE ADDRESS 45 r 41//4 /\O „ / )rV) OWNER'S NAME 730-1.A.A.-e,"7 5 OWNER ADDRESS \ " e 3 T L 3'77 -/G / FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL cia PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:13Z1_- PLANS SUBMITTED: YES❑ NO 0 FIXTURES Z 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAW L INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN , SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES fiZ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY OTHER TYPE 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. 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. _ PLUMBER'S NAME r 1 Itc N'c a r LICENSE# 19 G g/ SIGNATURE MP❑ JP IX CORPORATION❑# PARTNERSHIPS 1❑#5 / l C❑# � J 1 J /'r COMPANY NAM f .c )C'ç9— ADDRESS r�VG CITY V . g C M d�i 6 STATE1k4._ ZIP O C G3 73 TEL ?7 yz--0/a !) 7.--Z FAX CELL EMAIL n y Pf !h ' ('') [_r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1- ('a BLDP-21-006599 S ,�. i�� CITY YARMOUTH MA DATE May 14, 2021 PERMIT # JOBSITE ADDRESSLl: WILD HUNTER RD OWNER'S NAME POWERS KEVIN D G OWNER ADDRESS POWERS JULIETTE C 34 WILD HUNTER 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 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 0 NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ 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-GASFITTER NAME Michael Mcbride LICENSE # 19681 SIGNATURE MP ❑ MGF ❑ JP 0 JGF ❑ LPGI ❑ CORPORATION El # PARTNERSHIP El # LLC El # COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride a(�gmail.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 PE FORM GAS FITTING WORK 7.;.1:ila ;,zr� t:t . CITY: /. //)ci1 r MA. DATE S`!1 Z/ PERM T# JOBSITE ADDRESS: 3 L/J/1/ L/q I�j,,(1 PJ 4_1 OWNERS NAME: /`1•'1/1 / -e GOWNER ADDRESS: -72I3 TEL: 7-/z7 // FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL( , PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI i I tD: YES El NO IS- APPLIANCES-1 FLOOR-' 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 i ' LABORATORY COCK f Cs MAKEUP AIR UNIT OVEN POOL HEATER ROOM t SPACE HEATER _ J ROOF TOP UNIT ' TEST UNIT HEATER f,U UNVENTED ROOM HEATER ` WATER HEATER ( r 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY l OTHER TYPE INDEMNITY ❑ 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 0 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 In compliance with all Pertinent provision of the Massachusetts State.Plumbing Code d Chapter 142 the General Laws. n qq q �� i? PLUMBERIGASFITTER NAME: r' (,�I t C4f' CENSE#1/ �� GNATUR t COMPANY NAME:'1\1l�7,1, f , ----11-- ADDRESS: C t V(J� c Il L 1 i U� CITY: ( 1 ) 1 L( tO C Y U TATE:1,/tt ZIP: 6 2 6 713 FAX: TEL:) / q(O 11 ZZ CELL: EMAIL: .- 1"I!1 j-e/' • M r',cc- 4,1, bc44/,L'c MASTER❑ JOURNEYMAN, LP INSTALLER❑ CORPORATION❑# St'LP PARTNERSHIP❑# LLC❑# c h''/,L_ , 7 Z SS :