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HomeMy WebLinkAboutBLDP-22-000389 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,.- CITY YARMOUTH MA DATE 7/21/21 PERMIT# BLDP-22-000389 11-6 JOBSITE ADDRESS 111 LEWIS RD OWNER'S NAME ARCONTI MAUREEN A TRS P OWNER ADDRESS DRISCOLL A&MCKENNA C F TRS 16645 LAKE CIRCLE DR UNIT 733 FORT TEL MYERS,FL 33908 TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO 0 FIXTURFS ' 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❑ 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 Kevin Sullivan LICENSE MA SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Ready Rooter,Inc. ADDRESS P.O.Box 371 CITY Sandwich STATE MA ZIP 02563 TEL 5088886055 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK —_ Y _: �71 =g' � a CITY YARMOUTH MA DATE July 21, 2021 PERMIT# BLDP-22-000389 JOBSITE ADDRESS 111 LEWIS RD OWNER'S NAME ARCONTI MAUREEN A TRS G OWNER ADDRESS DRISCOLL A & MCKENNA C F TRS 16645 LAKE CIRCLE DR UNIT 733 FORT MYERS TEL FL 33908 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: ' PLANS SUBMITTED: YES ❑ NO El 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 El 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 Kevin Sullivan LICENSE# MA SIGNATURE MP © MGF ❑ JP ❑ JGF ❑ LPG' ❑ CORPORATION 0 # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: Ready Rooter, Inc. ADDRESS. P.O. Box 371, CITY Sandwich STATE MA ZIP 02563 TEL 5088886055 FAX CELL EMAIL S310N M31A3i1 NVId #111N2i3d $:R33 ❑ ❑ 1II1 J3d 3H1 SV SAS NOI1VOIlddv SIHI oN saA S310N NO1103dSNI 1VNId AINO 3Sf1 NO133dSNI?JOd 3OVd SIHl S310N N01133dSNI SVO HOflO