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HomeMy WebLinkAboutBLDP&G-22-003906 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y, g CITY YARMOUTH MA DATE 1/13/22 PERMIT# BLDP-22-003906 11 JOBSITE ADDRESS 59 CARVER RD OWNERS NAME HERAGHTY MICHAEL J P OWNER ADDRESS HERAGHTY KATHLEEN WALSH 27 LEDGEVIEW DR NORWOOD,MA 02062 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 FIXTURES 1 FLOORS RSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILJSAND 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF 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 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 Charles Markarian LICENSE tt4A SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME The Pipe Doctor ADDRESS PO Box 2227 CITY Hyannis STATE MA ZIP 02601 TEL FAX CELL 5087756670 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 ekr,,,,rr— .` BLDP 22 003906 e= CITY YARMOUTH MA DATE January 13,2022 PERMIT# JOBSITE ADDRESS 59 CARVER RD OWNER'S NAME HERAGHTY MICHAEL J G OWNER ADDRESS HERAGHTY KATHLEEN WALSH 27 LEDGEVIEW DR NORWOOD MA 02062 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Ill PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO Q FIXTURES FLOORS—0 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 © 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 Charles Markarian LICENSE# MA SIGNATURE MP© MGF 0 JP❑ JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: The Pipe Doctor ADDRESS. PO Box 2227, CITY Hyannis STATE MA ZIP 02601 TEL FAX CELL 5087756670 EMAIL S310N M3IA321 NVld #1IW2I3d $ :33d ❑ ❑ 1114k13d 3E11 SV S3AH3S NOI1VOIlddV SIHI oN sai S310N N01103dSNI 1VNId AlNO 3sn :10103dSNI 2110d 30Vd SIH1 S310N NO1103dSM SV9 Hona