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Home My WebLink AboutBLDP&G-22-03124 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, CITY YARMOUTH MA DATE 11/30/21 PERMIT# BLDP-22-003124 44—„11 JOBSITE ADDRESS 47 DEACON ST OWNER'S NAME OLSEN MARYBETH P OWNER ADDRESS SUDBEY BRIAN 47 DEACON ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTIIRFS 1 FLOORS—. RPM 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 0 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 John Kane LICENSE 2Q755 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'JOHN KANE ADDRESS 39 MONOMOY RD CITY S YARMOUTH STATE IMA ZIP 1026641984 I TEL I FAX 1 1 CELL 1 1 EMAIL Isjk1725@gmail.cam 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 FORA PERMIT TO PERFORM PLUMBING WORK s�`:1 . CITY 47 /Qvrn0 i.#Pt MA DATE I 1301 aoat 2 1 PERMIT t- 1 ' 1 17- 1 JOBSITE ADDRESS 44 7 D _,r S I A p OWNER'S NNE Pia g 1� 5 Udy If OWNER ADDRESS 5cimL TEL EL Sa______ r___ FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONALc PRIPIT 0 P,ESIDJ��T IAL CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: PLANS SUoMI I i ED: YES 0 NO FIXTURES 1 FLOOR-J. BSMT 1 i ? 3 e 5 I o 17 I 8 I 9 �� l i i i I BATHTUB 1 �z J 13 j ;r I CROSS CONNECTION DEVICc I I I DEDICATED SPECIAL WASTE E SYS I DEDICATED GAS/OIUSAND SYS I 1 I I DEDICATED GREASE SYS I I I I I DEDICA T D GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN i DISHWASHER FOOD DISPOSER I I FLOOR/AR=ADRAIN I I i 1 INTERCEPTOR(INTERIOR) I 1 KITCHEN SINK I I 1 LAVATORY. .- I ROOF DRAIN.' ■ SHOWER STALL T I SERVICE!MOP SINK I I TOILET URINAL $. 1 WASHING MACHINE CONNECTION I I I ) I WATER H=ATEi?ALL TYPES i I I WATER PIPING f - OTHER I I i 1 I I I 1 i l i INSURANCE COVERAGE: I 1 ( I 1 have a current liability insurance policy or its substantial equivalent which,meats the requirements of MGL Ch.142. Yes E( No IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 0 T 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 Owners Agent CHECK ONE BOX ONLY: OWNER 0 AGENT 0 I hereby certify that all of the details and information I have submitted (or entered) regarding this a plicationbest of my Knowledge and that ail plumbing work and installations performed under the permit pissued forre th s�applic application willte and accuratetbete in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME Td hr Ida r<- SIGNATUREel.....-,-- LIC# .- S S Mp❑ Jp f CORPORA110N #❑ PARitIERSHIP LLC 0# COMPANY NAME KQnc Ko nfracfrry ADDRESS: 39 r74n)me?y 1?al ' cm' S. yaren STATE Ma ZIP 0D66(1EMAIL. JKancE4S' y l,.ap 'cow. TEL CELL SO Y - 5'-56S6 FAX MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'e: CITY LARMOUTH MA DATE November 30,202' PERMIT# BLDP-22-003124 I 4 JOBSITE ADDRESS 47 DEACON ST OWNER'S NAME OLSEN MARYBETH G OWNER ADDRESS SUDBEY BRIAN 47 DEACON ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL EI PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY 0 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 (John Kane LICENSE# 22755 SIGNATURE MP❑ MGF ❑ JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: JOHN KANE ADDRESS. 39 MONOMOY RD, CITY S YARMOUTH STATE JMA I ZIP 1026641984 I TEL FAX 1 CELL 1 'EMAIL Isik1725fa�.gmail.com S310N NVld #iIlN2f3d $:333 1:1 El 1I11213d 31{1.6V S3AH3S NOLLVOIlddV SIHl oN saA S310N N011D3dSNI 1VNIA AlNO 3Sf1210133dSNI 2103 3OVd SIH1 S310N N01103dSNI SVO HOflOH - -- ch{ck - - a 777 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK W'�':, P CITY Cj- yor rv► 0 u+t,. MA DATE I 1 t 3 0 t a'() "a- t PERMIT #_ -2 Z ' 1 12 `I JOBSITE ADDRESS 4.7 Dco CO n 5 i-' OWNER'S NAME Olcirl B t-t-h S i - (4,,LL.,,____ GOWNER ADDRESS Sq rot, TEL 5O f(`776 - 1-0-3 % FAX TYPE OROCCUPANCY TYPE COMMERCIAL ElEDUCATIONAL ❑ RESIDENTIAL (71 - PRINT i CLEARLY NEW: ❑ RENOVATION: I] REPLACEMENT: 2- PLANS SUBMITTED: YES ❑ NO APPLIANCES _ FLOORS-4 BSIVI 1 ? 3 4 5 6 7 8 9 " 10 11 12 13 I 14 BOILER BOOSTER `----i CONVERSION BURNER COOK STOVE —� DIRECT VENT HEATER DRYER, FIREPLACE 1 FRYC)LATOR FURNACE GENERATOR I GRILLE INFRARED HEATER f LABORATORY COCKS ? MAKEUP AIR UNIT j OVEN ' POOL HEATER _.- ROC}PJf I SPACE HEATER ' .�, ru 11 t.i! ! , ROOF TOP UNIT TEST UNIT HEATER • r 1I , UNVENTED ROOM HEATER _ I WATER HEATER : ; OTHER ,yr, , , ----1 �._... 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1 NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY j OTHER TYPE INDEMNITY ❑ BOND ` I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage1 � 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 mykn and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provisi n of the odge �- Massachusetts State Plumbing Code and Chapter '142 of the General Laws. L kPLUMBER-GASFIT"f ER NAME ., �`"' LICENSE # d"13,75'g` SIGNATURE MP ❑ MGF El JP ( JGF ❑ LPGI n CORPORATION ❑ If PARTNERSHIP ❑ It. LLC COMPANY NAME Kar+c 1<On-fro cf.1 h y ADDRESS 3 cf yno nil en n�/ y CITY S /orrYou4-L STATE nla ZIP izya. 6 b Li TEL FAX CELL 5 0 $ - b li - re S-t) EMAIL 3 kc a n C€L S v Y 4 A 0 v . cocoh RQi1Gi3 GAS IPfSPE€ �I�If NoTEs THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES