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HomeMy WebLinkAboutBLDP&G-22-004681 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK h f CITY YARMOUTH MA DATE 2/24/22 PERMIT# BLDP-22-004681 ce JOBSITE ADDRESS 16 MARGARET JOSEPH RD OWNERS NAME JOLLEY ELLEN M P OWNER ADDRESS 16 MARGARET JOSEPH ROAD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURFS • 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 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 0 OWNERS 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. PLUMBERS NAME (Andrew Leighton LICENSE 16130 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 I TEL FAX CELL EMAIL halloilcompany@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES _ ACH .€SETT N FOR APPUCA' N FOR A PSI i TO PERM GAS FITTING WORK _ CITE' lo /4?, V_C,t.) T 2`f 7.)©R7- - MA DATE !.s .4.2Z pERT# LT �{(o l JOBSITE ADDRESS (( IV 0116 0 a e t g-e/O 14OWNER'S NAME -- ' G OWNER ADDRESS `/ r r FAX FAX T EL FAX TYPEOROCCUPANC`,''TYPE COMME.' �fAL 'i-T EDUCAIDNAL RESIDENTIAL CLEARLY NE : _.- RENOVATION: R.. L�CEt EK T: / '`• - PLANS SUBMITTED: YES NO I, APPLIANCES I FLOORS—, ' 3swi 1 1 2 i 3 } 4 ; 5 € a 7 f 8 ! 9 ' 10 1 i 12 ( 13 14 BOILER c < `' # 1 �h�+ . j i 1 ' a BOOST R i CONVERSION BURNER ` I 1 _ ' t ii k i # - COOK STOVE 1 l I j ! I I t I E T . DIRECT VENT HEATER z rI. i i I j i1 t DRYER i t i •I : t i E FIREPLACE ! l i 1 FURNACE , - t , � t GENERATOR € # 1 -? f GRILLE ' F f ` t t k 1 ' INFRARED HEATER i # _ F - t _ t . # f I # ` - - - I.APOf�ATORY COOKS t - .i ._ - I - I- j k ` t a ( I t �I MAKEUP AIR UNIT ` _ ` OVEN ` _ _ i - - t i , not.HEATER T - _ z __ ROOM f SPACE HEATER _ ' . # ` ' t i 12: ROOF TOP UST L. ' ! - • TEST :r i I -- uNII T €-A T:.,R i r i . l 1 z . # ! _ UNVENTED ROOM HEATER i WATER HEAT ER - _ _ I I t f OTHER ` ; # I S 1 I ' f r [ t • 4 i { ! 1 1 ---I # I £ INSURANCE COAt rent liability Durance policyor it s>iuSiat idi equivalent whichthe requirements of NIGL. Ch.142 YES :1/ NO Ihzveac t I IF YOU CHE C D Y PLEASE SE INDICATE THE TYPE OF COVERAGE BY CHECKING THE • PR PRIAT E BOX BELOW LIAMLITY INSURANCE POLICY V OTHER -=INDEMNITY BOND O ER'S INSURANCE ViAil,ER I arn wars that the licensee does not a=the i - rams coverage required by Chapter 142 of the I Iassachuse General Laws,and tha my signature on this permit apply r; _-- this requirement. CHECK ONE C : OWNER AGENT SIGNATURE OF OWNER OR AGENT - / -- ` I hereby t '!?all of ra Erfor cy: i have submit ea 't� or 2red rag a _an are and - i - of•n KiTOl�ge rn anti that an piubn2g work and latone pritan Zd tatter Ma merit€SSUed for this appii—...•n te In pilaw., 'yrs•' - -- •£!A of the Massachusetts Statr Pfunbiria Code and Cher 142 cf the General Laws. - t - i PLUMBER GASFtIT R NAME ANDREW i GII-E CN LiCENSE 151304 SIGNATURE MP ' M F JP JGF PGi CORPORATION { :T 3734C PARTNERSHIP A t ERSHIP LLC # COMPANY NAME HALL OIL COMPANY r INC. ADDRESS R I CITY SOUTH DENNIS STATE MA ZIP TEL 508-398-3831 FAH 508-394-3058 GEL_ EivikiL loIcQml yegmail-u'T 1 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ‘L.7,111 CITY YARMOUTH MA DATE IFebruary 24,2022 I PERMIT# BLDP-22-004681 JOBSITE ADDRESS 16 MARGARET JOSEPH RD OWNER'S NAME JOLLEY ELLEN M G OWNER ADDRESS 16 MARGARET JOSEPH ROAD YARMOUTH PORT MA 02675 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL Q 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND ❑ OWNERS 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP©MGF 0 JP❑ JGF❑ LPG! 0 CORPORATION❑IS PARTNERSHIP 0# LLC❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. I20 Brewster Rd, CITY IW Yarmouth I STATE MA ZIP 026735706 TEL FAX CELL EMAIL IhalloilcompanytWgmailcom S310N M3IA323 NVld #11M d $:33d 111U3d 3H1 SV S3Aa3S NOI1V3llddd SIHl oN saA S310N NOI103dSNI 1VNId AlNO 3Sl 210103dSNI dOd 3OVd SIHl S310N N01103dSNI SVD H9flO S. 't { MASSACHUSE T S UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I r 'M-----t, 1 MA DA C U 2 PERMIT= "L (�. �. Cfr Y n_97 0_ f� •"1 `, .. + x mo ��t, ose i OWNER'S NAME; gh' A� j03SITE ADDRESS Z�v /��R�i l9 Pei 'f 3"; //e7 . OWNER ADDRESS _ iEL .Vg' 'P%-r9.?7Fpy; Y TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL IAL 7-7( ..; TYPE OR OCCUPANCY _ _ PRINT PLANS SU$I�+IIITT 1.: YES h14=�' CLEARLY i NEW: RENOVATION: REPLACEMENT:CEMENT: cc i FLOOR— ! 38M ; ' 1 3 ; j 7 819 ' :C FIXTURES -= - - TH T t�a =' -- CROSS CONNECTION:ON DEVICE . _ _ .._... . DEDICATED SPECIAL WASTE SYSTEEM -- _ = - . DEDICATED ED GAS/OILJSANDSYSTEM - - 1:==— .�._..._.._ --- DEDICATED GREASE SYSTEM s�._ — - - __ - { DEDICATED GRAY WATER SYSTEM c -- - _ -•_ - __. TER RECYCLE SYSTEM - ' DEDICATED WA i ______ =� DISHWASHER _ _ - -DRINKING FOUNTAIN :__-_ ' lisigspr FOOD DISPOSER - -- _ I FLOOR/AREA DR N - - I INTERC ✓ OR(INTERIOR) - = KITCHEN SINK aiiiINICIWWWWW.C111111111 .011111111•111 -WSW — LAVATORY - F DRAIN ' SHOWERO STALL s ,_ WF F ' - OP SINK $ - - ---- - - SERVICE _ __ __ 11111 TOILET URINAL - - - W_�_�- - - --_--- WASHING MACHINE CONNECTION - - _ _ _ _ -__ _ WATER ALL TYPES, _ _ . WATER Da OTHER -- -- _ -- - - - -- - ._ - -- INSURANCE of MGL Ch. 142 `'ES � NO which meets the requirements --= I have a current lia�ity insurance policy or its substantial equivalent IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKINGTHE APPROPRIATE BOX BELOW ` LIABILITY INSURANCE POLICY 71 . OTHER TYPE OF INDEMNITY BOND --= OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage by Chapter'Id,Z of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: 0 •.ER AGENT OR AGENT __ SIGNATURE OF OWNER - - �� = to t� z - �� I'�o� thisa Ir-i..• F hereby �Y that all of the details and StifOiTr ial'soil I have submitted or enteredrmg w�i -- in �►p� ea with :1 P= ' :-, �-ion of th end that all plumbing work and installations performed under the permit issued application _ Messadi usets state Pluming Code and Chapter 142 of the General Laws_ --+G- ----- MP PLUMBER'S NAMEANDREW LEICHTN I LICENSE YT6130-M �GNAIURF JP CORPORATION; •- =� 3734E __SPAR{NERSI-HP .J L .- _�.. -C { -- = COMPAN'! NAME' _HALL OIL COMPANY INC. ADDRESS i 435 RT 134 _ CITY; SOUTH DENNIS i STATE MA ZiP { 02660 1 TEL 508-398-383 i 77-liX . cnRa94:-3 68 i CELL s ENTAIL = halloilcornpri A Liko i' — -. �.�.._. — -