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HomeMy WebLinkAboutBLDP&G-22-001831 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 CITY YARMOUTH J MA DATE 9/30/21 PERMIT# BLDP-22-001831 JOBSITE ADDRESS 7 RITA AVE OWNER'S NAME MANN PHILIP G P OWNER ADDRESS MANN JUDITH E 7 RITA AVE SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL m PRINT CLEARLY NEW.❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES I FLOORS— RSM 1 2 3 4 5 6 7 I 8 9 10 11 12 13 14 , BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK 1 LAVATORY 3 1 ROOF DRAIN SHOWER STALL 1 1 SERVICE/MOP SINK 1 TOILET 2 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 TYPE 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 at 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 at 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 Eric Whiteley LICENSE 145920 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME W Vernon Whiteley ADDRESS PO Box 1299 CITY West Chatham STATE MA ZIP 02669 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . `al:_-, CITY YARMOUTH MA DATE September 30, 2024 PERMIT# BLDG-22-001836 t JOBSITE ADDRESS 7 RITA AVE OWNER'S NAME MANN PHILIP G G OWNER ADDRESS MANN JUDITH E 7 RITA AVE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST 1 _ , UNIT HEATER UNVENTED ROOM HEATER i WATER HEATER 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 ElOTHER OF INDEMNITY❑ BOND El OWNER'S INSURANCE 'NAIVER: 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. SI3NATURE 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 perrrit 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 Eric Whiteley LICENSE # 15920 SIGNATURE MP ❑ MGF 0 JP ❑ JGF ❑ LPGI ❑ CORPORATION 0 # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: E'l Vernon Whiteley ADDRESS. PO Box 1266, CITY West Chatham STATE MA ZIP 02669 TEL FAX 1 CELL EMAIL S310N M3IA32J NVId #1IIN2l3d $:33d ❑ ❑ 1I11213d 3H1 SV S3A213S NOIiVOIlddV SIR! oN seA S310N NOLLO3dSNI 1VNld A1NO 3sn NO103dSNl 210d 30Vd SIHl S310N NOLLO3dSNI SYS H'Jl02J