Loading...
HomeMy WebLinkAboutBLDP&G-23-001074 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK v— CITY YARMOUTH MA DATE r129/22 PERMIT# BLDP-23-001074 JOBSITE ADDRESS 46 JOHN HALLS CARTPATH VILL OWNERS NAME Steve Berglund P OWNER ADDRESS 46 JOHN HALL CARTWAY YARMOUTH PORT,MA 02675-1400 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES • 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❑ 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❑ 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 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 Michael Welch LICENSE 117607 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL L WELCH ADDRESS 991 OAK ST CITY W BARNSTABLE STATE MA I ZIP 026681525 TEL FAX CELL EMAIL mickwelchyl@yahoo.com ROUGII 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 PLUMBING WORK =I,_ .i ;C CrI E LfjA VY l-L- Po 2-t- MA DATE A ,,,,-/ Z,!,ZZ PERMIT# JOBSITE ACDRtSS b d(„y,�ff [( C�rZ{ i✓A y OWNER'S NAME t� G?�< Lc, U� OWNER�ADDREiSS a - TEL FAX \froidgG Dbai,X YT"PE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL f CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:g- PLANS SUBMITTED: YES❑ NO❑ FIXTURES T 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) i KITCHEN SINK LAVATORY , ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER II _ 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 UABIUTY 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 tfts permit application waives this requirement. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LU I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac the best my knowledge and that all plumping work and installations performed under the permit issued for this application will be in co is th all P nen sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,4/ PLUMBER'S NAME \;ti t`1 - 1'1 ' �� --(--- LICENSE# 76 02 SIGNATURE MP❑ JPn— CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME btit\Y-e W d G tt P!y ADDRESS ?9! 01 K .S t CITY t,if�6T L� Q P✓s'e",J i- STATE t?�t- ZIP 0 - 6� TEL Se'<25- 776 /5 ° FAX CELL EMAIL 11'2 f Gjl,Ll-'''e 1 C 6/ yze 7,4 h or,60-m 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 kz...4'11BLDP-23 001074 CITY YARMOUTH MA DATE August 29,2022 PERMIT#Steve Ber JOBSITE ADDRESS 46 JOHN HALLS CARTPATH VILL OWNER'S NAMElund q G OWNER ADDRESS 46 JOHN HALL CARTVVAY YARMOUTH PORT MA 02675-1400 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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-GASFITTER NAME Michael Welch LICENSE# 17607 SIGNATURE MP❑ MGF ❑ JP© JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL L WELCH ADDRESS. 991 OAK ST, CITY W BARNSTABLE STATE MA ZIP 026681525 TEL FAX CELL EMAIL mickwelchy1(a.vahoo.com S310N M31/132i NVld #lfWH3d $ :33d ❑ 0 JI1A183d 3H1 SV S3A2i3S NOI1V011ddd SIHl oN seA S31ON NO1103dSNI 1VNld AlNO 3Sfl 210103dSNI 210d 3OVd SIHJ S31ON NO1103dSNl SVO H9110d ' = .a 'CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 � 4. r,`.- - r Mr, DATE A u a f 22- PERMIT UG 2 9 �I ZE ADD'ESS 4' C, .. 6 kW kfiA(i w.a > OWNER'S 0 ��qq�� FFR � (� NAME � '>� r�Qt2� D UI iDING OE�A IA-W; SS S 4tt4--�_ / TEL FAY, ` U1-'.ANCY I YPE COMMERCIAL❑ EDUCATIONAL_ T ❑ RESIDENTIAL 6-- CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: - PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 f ; 0 9 10 11 12 13 R BOILER � - 1 - BOOSTER r CONVERSION BURNER J COOK STOVE i DIRECT VENT HEATER DRYER _ _.�_, FIREPLACE i FRYDLATOR FURNACE 1 —I GENERATOR • GRILLEI J INFRARED HEATER ' LABORATORY COCKS -- ---• —i MAKEUP AIR UNIT _. OVEN POOL HEATER _L____� ROOM I SPACE HEATER ROOF TOP UNIT ' TEST - . UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER / OTHER I INSURANCE COVERAGE l I I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 25 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. 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 t the best of m knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comps nce i a 4nt prov n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `i PLUMBER-GASFITTER NAME WL lk:11- UALA-Q-"-Gir— LICENSE# 1-2 60-7 SIGNATURE MP ❑ MGF❑ JP g- JGF 0 LPGI ❑ CORPORATION 0 II PARTNERSHIP❑It LLC❑# COMPANY NAME V\-k--1 LJ..eDG lr tf2(y ADDRESS 99 l 0x 1 t CITY (A)•12;[ 6,e fkNs'/:0 STATE flt4t ZIP 0 2‘' TEL SL'd 776 / �O FAX CELL EMAIL nit c 1-4)-PlC11,y I P yhco Cfr►'!-t- ROUGH GAS INSPECTION NOTES. THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION t OTES Yes No THIS APPLICATION SERVES AS THE PERMIT ] FEE: $ PERMIT it PLAT' REVIEW NOTES