The URL can be used to link to this page

Home My WebLink AboutBLDP&G-23-000677 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w r CITY YARMOUTH MA DATE 819122 PERMIT# BLDP-23-000677 JOBSITE ADDRESS 21 BOXWOOD CIR VILLAGE OWNERS NAME Larry Gordon P OWNER ADDRESS 21 BOXWOOD CIR VILLAGE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY I NEW:0 RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES 1 FLOORS—, RSM 1 2 3 4 5 6 7 8 9 10 11 17 , 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 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 Richard Olsen LICENSE 10335 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD P OLSEN ADDRESS PO BOX 2026 CITY DENNIS STATE MA ZIP 026385026 TEL FAX CELL EMAIL office@olsenplumbing.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 - R R E C E -j D 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r7 CITY I I MA DATE 0 ] 7�� ZZI PERMIT# 'Z `5 c> �- _i.. JOBSITE ADDRESS ZA__hp X WSX001 Ci(Cl C ! OWNER'S NAME ‘ a Y` —__ BUILDING DEP MEND OWNER ADDRESS I_ __. _ __�.. I TELL D� ADZ I FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL H i RESIDENTIAL PRINT CLEARLY NEW: _a RENOVATION: ; REPLACEMENT: ! PLANS SUBMITTED: YES NOfl FIXTURES -1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ . _ __ . .. ..._. . - ---. -.... _........ - osilitia CROSS CONNECTION DEVICE I ' e = -;(� te DEDICATED SPECIAL WASTE SYSTEM i! i l DEDICATED GAS/OIUSAND SYSTEM 3 '14 „! .I '! DEDICATED GREASE SYSTEM —� !I r-- DEDICATED GRAY WATER SYSTEM ' �,.. _. -__.,7 .. G _ ..:, .. �:. _� DEDICATED WATER RECYCLE SYSTEM I DISHWASHER a DRINKING FOUNTAIN FOOD DISPOSER 1, FLOOR 1 AREA DRAIN r INTERCEPTOR (INTERIOR) ! _ KITCHEN SINK LAVATORY i-. - __—._ �_ ROOF DRAIN SHOWER STALL j,r 1 SERVICE / MOP SINK I, _=_ --- - _ _ o• TOILET _ URINAL i, i t WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES _ % u _ WATER PIPING I OTHER if - 1---- . — _ _ _ : . r s m - I , 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 I OTHER TYPE OF INDEMNITY ! BOND i___ 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 i 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 -knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' e wit rit,tinent ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ::.-- -------' PLUMBER'S NAME j RICHARD OLSEN ;LICENSE # ' M10335 SIGNATURE 0 ?#1 2166 'PARTNERSHIP # jLLCI?# _ MP JP CORPORATION�__ COMPANY NAME OLSEN PLUMBING & HEATING i ADDRESS ' 357 HOKUM ROCK ROAD CITY 1 DENNIS STATE MA I ZIP j02638 TEL 508-385-5290 FAX 508-385-6963 CELL EMAIL _ • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " CITY YARMOUTH MA DATE August 09,2022 PERMIT# BLDP-23-000677 JOBSITE ADDRESS 21 BOXWOOD CIR VILLAGE OWNERS NAME Larry Gordon G OWNER ADDRESS 21 BOXWOOD CIR VILLAGE YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES 0 NO El 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 ❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER 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 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 Richard Olsen LICENSE# 10335 SIGNATURE MP El MGF El JP El JGF El LPGI 0 CORPORATION 0# PARTNERSHIP El# Lc El# COMPANY NAME: RICHARD P OLSEN ADDRESS. PO BOX 2026, CITY DENNIS STATE MA ZIP 026385026 TEL FAX CELL EMAIL office(1a.olsenplumbinq.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R c ,as` ! E b 7 L— 1* : C Y �C3 L _ _� MA DATE 1h•CQrLOZ z PERMIT # 2 AUG QZ J BSI EADDRESS1 7�.L �ax- �06 . i(-C1 C _--_ OWNER'S NAME ,i..�YLv (5cLi0. BUILDING--GARTMEOWNERADDRESS ___ TELS U C01. FAX ay PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 1 RESIDENTIAL • CLEARLY ---- NEW: RENOVATION: REPLACEMENT: X PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1, 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 —�--_ ,_ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -I 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 TiAGENT 71 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 tot best ,y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wall P inn yi " of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / l ✓ - %Z :. PLUMBER-GASFITTER NAME Richard Olsen LICENSE # M10335i4 / SIGNATURE MP i MGF L I JP 7 JGF 7 LPGI CORPORATION i # 2166 PARTNERSHIP it;-�_ LLC # COMPANY NAME:' Olsen Plumbing & Heating ADDRESS P.O. Box 2026, 357 Hokum Rock Road CITY Dennis } STATE MA ZIP02638 TEL 508-385-5290 FAX 508-385-6_9631 CELL - — !EMAIL Off- C C f ?).--Q 11-T .1._N(fit•CO 'm _