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Home My WebLink AboutBLDP&G-21-007412 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/21/21 PERMIT# BLDP-21-007412 JOBSITE ADDRESS 32 FOREST GATE VILLAGE OWNER'S NAME WINER NANCY A TR P OWNER ADDRESS WINER REALTY TRUST NO 11 32 FOREST GATE YARMOUTH PORT,MA TEL 02675-1459 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: D RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS 4 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 D BOND D 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'S NAME Scott Andreasson LICENSE 1J794 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑ COMPANY NAME SCOTT ANDREASSON ADDRESS 37 ROBINS WAY CITY HARWICH STATE MA ZIP 026452513 TEL FAX CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES S PERMIT N PLAN REVIEW NOTES :I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK c� a4-_ CITY " C.%%,mac--'T 1(j T c J MA DATE ' 2-/ �` PERMIT# JOBSITE ADDRESS 1 'fPS) Coc-,t-e L OWNER'S NAME C-- ,�i& . i 1 T, OWNER ADDRESS TEL FAX J T$Pt OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT* PLANS SUBMITTED: YES ❑ No zi FIXTURES 1 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM " DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN - FOOD DISPOSER - , y FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) - - - KITCHEN SINK , LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK I TOILET j URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 - WATER PIPING OTHER _ 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 LI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the t Massachusetts General Laws, and that my signature on this permit application waives this requirement. 1 CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L.l I hereby certify that all of the details and information I have submitted or entered regarding this application ar 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 mpliance with It Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAMEC/t/�,1 '7`-"' LICENSE# /6,7 c.7". SIGNATURE MP JP❑ ORPORATION ❑# PARTNERSHIP❑.# tic❑# COMPANY NAMEC-C 4i Oki,'h ✓'C.€.1 ADDRESS �J��,1 + A-7 i 4—`7 CITY ,,iC--14 - I STATE'" ZIP C 7, `-1 TEL CAS - 1/4(3U-2-.77K FAX CELL EMAIL 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 '3: : wn, CITY YARMOUTH MA DATE June 21, 2021 PERMIT# BLDP-21-007412 JOBSITE ADDRESS 32 FOREST GATE VILLAGE i OWNER'S NAME WINER NANCY A TR G OWNER ADDRESS WINER REALTY TRUST NO 11 32 FOREST GATE YARMOUTH PORT MA 02675-1459 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: El PLANS SUBMITTED: YES ❑ 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 ❑ 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 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 Scott Andreasson LICENSE # 10794 SIGNATURE MP Q MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION El # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: SCOTT ANDREASSON ADDRESS. 37 ROBINS WAY, CITY HARWICH STATE MA ZIP 026452513 , TEL FAX CELL , EMAIL none 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 r ASSAACI USETTS UNIFORM APPLICATION FOR A PERIL TO PERFORM GAS FITTING WORK 1 ic R ` . �`=,; : 4.' CITY C f J MA DATE PERMIT ..- 7_�,•i ya , .) 4? `` t�v JOBSITE ADDRESS F 1 �cr OWNER'S NAME t 1-1-E0--�- 1SYr,�` Uj ! c\? G il - OWNER ADDRESS TEL FAX RAPI(Pk.704 — _, LEA ; pr rT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIce riLE.6%, .1 AL NEW: ❑ RENOVATION: ❑ REPLACEMENT PLANS SUBMITTED: YES NO APPLIANCES -I• FLOORS-4 BSM 1 2 3 4 5 6 7 o 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE I DIRECT VENT HEATER DRYER, 1FIREPLACE 1 FRYOLATOR FURNACE GENERATOR I GRILLE I I INFRARED HEATER 1, LABORATORY COCKS MAKEUP AIR UNIT OVEN l POOL HEATER . ROOM ; SPACE HEATER I ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER J WATER HEATER I OTHER )11ii_____. _____, INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of I11GL. Ch. 142 YESM NO fl 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 14.2 of the Massachusetts General Laws, and that my signature on this permit application krJaivn this requirement. -, CHECK ONE ONLY: OWNER ❑ AGENT n SIGNATURE OF OWNER OR AGENT 'i:: 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 Co and Cha er 12 of the General Laws. PLUMBER-GASFITTER NAME cc-/-1- Ac-/-ecia-c-6--7 LICENSE # - 1C �� SIGNATURE I\Ak MGF In JP n JGF n LPGI CORPORATION F PARTNERSHIP n # LLC ❑ : ' I / COMPANY NAM - c-- ,s' 1 1.7 _- ? /✓Lc C ADDRESS r-""e2 �a L �7-1 �jt CITY / 4 -/ILt/o/i, I STATE ZIP CJ�(Jp y � TEL ��- k - `��-�7)k FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes N THIS APPLICATION SERVES AS THE PERMIT • ❑ ❑ FEE: 1, PERMIT it PLAN REVIEW NOTES • •