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HomeMy WebLinkAboutBLDP&G-23-000761 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u- (0 CITY YARMOUTH MA DATE 8/15/22 PERMIT# BLDP-23-000761 JOBSITE ADDRESS 1 MIDIRON DR J OWNER'S NAME WHITE THOMAS B P OWNER ADDRESS 1 MIDIRON DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATIONS.❑ 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE 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. PLUMBERS NAME Nicholas Losordo LICENSE 15858 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS P.O.Box 954 CITY Eastham STATE MA ZIP 02642 TEL FAX CELL EMAIL mlosordo@hotmail.cow ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 111 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK bra--I eip . ril CITY Yarmouth MA DATE 8/12/22 PERMIT # z 5 "- C 7 C JOBSITE ADDRESS .1 Midiron Drive 1 OWNERS NAME Pouliot OWNER ADDRESS FMidironDnve I TEL FAX J 1 TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: Li REPLACEMENT: PLANS SUBMITTED: YES ...... NO FIXTURES Z FLOOR-, BSM 2 3 4 MI 6 7 8 9 10 11 12 13 14 BATHTUBL1111111 11111111 11111111 1 CROSS CONNECTION DEVICE '' FfF DEDICATED SPECIAL WASTE SYSTEM . .. ,: ., pow DEDICATED GAS/OIL/SAND SYSTEM _ ��....... > .... ...�............ =maw .I .i .... .- DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM . 3 ' � , DEDICATED WATER RECYCLE SYSTEM miammiwirminicamomminimmulasimim DISHWASHER � I DRINKING FOUNTAIN FOOD DISPOSER alliallifirieRWManirWomilmitommarMMOdi FLOOR 1 AREA DRAIN emilmuilamialarneramamain ammainntamelimilmit INTERCEPTOR (INTERIOR MM. ,FMMWIIjlMltaltMIMMMMMMIMI1M11 KITCHEN SINK innumemalimmemmiturni LAVATORY INIMIMEMIMNINTWanaWM10.411MWasonslow ROOF DRAIN SHOWER STALL : I ' SERVICE / MOP SINK ... ... . ;.. , ,.. ..I , .... .. .... 1 ... ... I. . ' TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES MIME 1111.111111111111111111111111111111111Maimmatanimlaillait . ... WATER PIPING OTHER �___�__,,, 1111111.111111111111MalliallIMIMMOMMI i , , ICI :.......: .... .: . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ej NO Ej IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , OTHER TYPE OF INDEMNITY nn.,. BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachu 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 to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,644 PLUMBER'S NAME [Nicholas Losordo LICENSE # 16858-MJ " SIGNATURE MPL,: x JP CORPORATION #1 PARTNERSHIP J LLC J#1 ��— 1 xavvu wavmvuv,awvmv`aavw:. va``avvwvovv,�mvvwavU vvo COMPANY NAME Nicholas Losordo J ADDRESS IBOT—c954 XIMMISMISSICRVAJ r CITY IEastham STATE F. MA _ ZIP '02642 TEL 77-722-5031 FAX CELL re-,__ I EMAIL mlosordo@hotmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'r' CITY YARMOUTH MA DATE (August 15,2022 I PERMIT# BLDP-23-000761 JOBSITE ADDRESS 1 MIDIRON DR OWNER'S NAME WHITE THOMAS B G OWNER ADDRESS 1 MIDIRON DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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/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❑ 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 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 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 Nicholas Losordo LICENSE# 16858 SIGNATURE MP©MGF❑JP 0 JGF 0 LPG( ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ADDRESS. P.O.Box 954, CITY Eastham STATE MA ZIP 02642 TEL FAX CELL EMAIL mlosordmU/hotmail.com y S310N MRIA32i NV1d #iIV f d $ :333 ❑ ❑ 111%13d 3H1 SV S3A213S NOI1V011dd`d SIHI oN saA S310N N011O3dSNI 1VNId A1N0 3Sf H0103dSNI NO3 30Vd SIH1 S310N N0llORdSNI SVO HJl02i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 =1,1; ,.,.,. CITY Yarmouth oars_ aa.. �aw a««�,.AA«..«�«Ww.«««-««-� MA DATE $/12122....n........,....... JPERMIT # Z 3 " 7 G ( JOBSITE ADDRESS 1 Midiron Drive i OWNER'S NAME ,Pouliot OWNER ADDRESS 1. M i d i ro n Drive I T E LI.,...«._....�..��a«..w«�a�...;;.,.,.,>.,;...:...:.....................k FAX s...wwww....,w.......w,...,............ 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' nom WATER HEATER EI w „ .,...,._....w. ww..rw ,.` .w ,, _......_ . a lI • tvaawwawgr.,,w<,•aw„vnv„aw ? a? V:.•, •, .... ... .. E ..,,,u,,.n, ....,..,,>,,, w, ,,.,,,.,. =w .,.,,az ,wwww,,..w, wwwvaw \yrc,\ .,,,;,,,,,.w,,.,,,,,,,,w a w.w wK t¢.w w,e�w w w,,,w y w.ww„ww, C i e wwwww H,. „a< .w ,w , OTHERS g 3 a i sa iw g ai .> E a+ x 6. N. �E€��... .. 6E.. .... <, , .. ,. .. .,,,,......,�. ..,...,... .,..... ,,.v.,,.,.,,... w............... ,,,.......>...> \Z K3 it Ea S � n: � ai x ,aw 0 P ax i ,., "Aii.<44f<5$,M4(,ttu4�u4�fi## 0.<W0AbvudSiux$K i.'gq,i4 f34$4MYUb.,J, c s , (>w>,•,,,, \ ... \ v ... w, pp• a• K t. • w..,...,w.,.,,,,A.,.M>.aw.,„,..>.,w..>..,,,,,wwwww,,,,, .MwwwvKwwwAw.<..ww ., i . s, x. E „ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I v 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 Li 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 si nature on this permit application waives this requirement. ...,... 1 /0L14/Pr'''4 CHECK ONE ONLY: OWNER AGENT r,i„a.>E 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 complia with all Pertinent provisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ?Nicholas Losordo LICENSE # 16858-M SIGNATURE MP $ `�" MGF JP jT. JGF LPGI ..\ CORPORATION # ««>-uu-p���e�� $ PARTNERSHIP # ;jLLC ri ...u,.... ,�A�a a _..� �n �w. A txxxx a tsce ttauwzv f uwa4x• COMPANY NAME:INicholas Losordo ADDRESS Box 954 CITYEastham ................._...._._...,,.,..,,,,,._,....,.......,.,N.., ,,...........ww. ,......,.......,,,_...._. .................._.._..,.,.,,,,.. STATE MA... [ZIP 02642... m.................. TEL774-722-5031M. w.. _w,.v.........o... .. CELL`_r..rr...w,,,....,...,,,,.,,.,... .................,., FAX EMAIL=mlosordo@hotmail.com.u...uNu......_ _.. ........__......,.�.•.__, _ w,�., _,,.__.�.,_ w N....,,,..•.W. ._..._. �___..._.._._..,.. .•xxxxxxx K xxxxe«MOSKxKxxsax... Ax.AKAAttxaaA.AAAx.xxxx.xxAA..xA.K ww.,...,w��.....,,,,.....,.w,n..,...,,., w„w..,.,,.,.w,..www.,,,,,, n..,,.,....,...nw„ww.,ww.<..,,....,..,.,.,,...............,,. w..,.�.....,,,,.,.....,w ,