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HomeMy WebLinkAboutBLDP&G-22-003973 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK roa CITY YARMOUTH MA DATE 1/18/22 PERMIT# BLDP-22-003973 1�s' JOBSITE ADDRESS 15 SIERRA WAY OWNER'S NAME COSTA DONALD A P OWNER ADDRESS 15 SIERRA WAY WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS 1 FLOORS-. RAM 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 0 NO 0 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 codify 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 James Oconnor LICENSE 14989 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JAMES OCONNOR ADDRESS 117 GREAT MARSH RD CITY CENTERVILLE STATE MA ZIP 026322413 TEL 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 ti I s SACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK T==,._ .-_I{— P: ,r„•../tt" MA DATE 1 / S Z-z. PERMIT# CI-- 3"�3 'E 1 8 20 2SIT AuDRESS i 5 S i e r-.. t�Il,., OWNER'S NAME C TR 3UILD UEFJA NDRESS TEL FAX 3Y _ TYPE OR DtCOP1-01CY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:V PLANS SUBMITTED: YES❑ NO FIXTURES 1 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/AREA DRAIN _ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY • I ROOF DRAIN _ SHOWER STALL i SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER i I 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 POUCY V 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 1 Massachusetts General Laws, and that my signature on this permit application waives this requirement. _ CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L I 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. g4;,.... C----.._..., PLUMBERS NAME LICENSE# ILwi . 0SIGNATURE MP[V JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC Ulf COMPANY NAME .' ►in Cx.«n�j� /I S A I1 ILA ADDRESS // 7 (j re,4 /M zrk Rd CITY (s -.4cr1:r Ic STATE Pi A ZIP 016-, 2 TEL FAX CELL `77'1 3„53 1736 ` EMAIL 3/171 ci rn. )-?l„_n.1,Jp e .'Ae/ 'CAI 4' ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE 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 y BLDP-22-003973 filt=f CITY YARMOUTH MA DATE Januar 18,2022 PERMIT#- C_`u JOBSI—E ADDRESS 15 SIERRA WAY OWNER'S NAME COSTA DONALD A G OWNE.R ADDRESS 15 SIERRA WAY WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111 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 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❑ 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 James Oconnor LICENSE# 12989 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: JAMES OCONNOR ADDRESS. 117 GREAT MARSH RD, CITY CENTERVILLE STATE MA ZIP 026322413 TEL FAX CELL EMAIL S310N M3IA32!NVId #infOnd $ 33d 0 El lI Wi13d 1E11 SV S3A213S NOI1VOIlddV SIHl oN saA S3LON NO1103dSNI 1VNId A1NO 3Sfl Oi33dSNI NO 3OVd SIH1 S310N NO1103dSNI SV0 H`Jf1Oa • •SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i=,fir=- ` �;,, CC�122TY .. - ham, DATE / /$ ?_ Z. PERMIT# 'Z Z- 3 9 3 18 0 DSl E,•'DRESS /- Si f K KA ( )A.1 OWNER'S NAME C.c�; I�q •u 11 0 E E I ADDRESS 'Y . TEL FAX PRINT` OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ElY CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT: [il/ PLANS SUBMITTED: YES 0 NO E2( APPLIANCES 1 FLOORS BSM j 1 2 3 4 5 6 7 0 BOILER 9 to 11 12 13 La BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER j -- FIREPLACE �-- FRYOLATOR - FURNACE GENERATOR GRILLE �-- INFRARED HEATER - LABClPJaTORY COCKS MAKEUP AIR UNIT -'`-- OVEN • . POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST , UNIT HEATER INVENTED ROOM HEATER WATER HEATER / ' —p OTHER —T- L GE I have a current liabili insurance policy or its substantial equivalent INSURANCE which the requirements of MGL.Ch.142 YES q �NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E / 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. SIGNATURE OF OWNER OR AGENTCHECK ONE ONLY: OWNER ❑ AGENT ❑ 4-; 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. Q1 PLUMBER-rASFIT7ER NAME -- 37.--� LICENSE# i�9 2 9 SIGNATURE MP MGF❑ JP ❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑It LLC Q A-ICOMPANY NAME 1 I 01 ()LoNr00,.- r))« S ,Q li ADDRESS / /7 Grc��j Arssi" RJ CITY C. cv,i L, I/C STATE/1^fl ZIP 0Z.6SZ TEL FAX CELL77 y 1S3 F3e2... EMAIL 1 MG.X annV' Jl+,►+b. rPJ 5 ROUGH GAS INSPEC' 'IQN I Q` 'E,S THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes N THIS APPLICATION SERVES AS THE PERMIT J PEE: $ PERMIT ft PLAN REVIEW NOTES