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HomeMy WebLinkAboutBLDP&G-21-007080 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/7121 PERMIT# BLDP-21-007080 TI-- JOBSITE ADDRESS 22 SYLVAN WAY OWNER'S NAME MIRANDA JOSEPH A P OWNER ADDRESS MIRANDA KATHY C 103 KNOB HILL RD MERIDEN,CT 06451 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATIONS.❑ 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 m OTHER TYPE 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 at plumbing work and installations performed under the permit issued for this application wit be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Donald Mercier LICENSE 3t1082 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑V COMPANY NAME DONALD R MERCIER ADDRESS 4 WILDWOOD WAY CITY SANDWICH STATE MA ZIP 025632686 TEL FAX CELL EMAIL bcph08@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT El ❑ FEES S PERMIT# PLAN REVIEW NOTES 4 I "',. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK L'%',: *- - CITY South Yarmouth MA DATE 06i07/2021 PERMIT # _ _ - JOBSITE ADDRESS 22 Sylvan Way OWNER'S NAME Joseph Miranda POWNER ADDRESS Same TEL 203-915-3091 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL vi PRINT CLEARLY NEW: RENOVATION: • REPLACEMENT: ✓ PLANS SUBMITTED: YES NO:f FIXTURES 1 FLOOR--4 BSM 1 2 3 4 ` 5 6 7 8 9 1 10 11 ; 12 13 14 BATHTUB CROSS CONNECTION DEVICE I I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS'OIL/SAND SYSTEM -----------DEDICATED GREASE SYSTEM { DEDICATED GRAY WATER SYSTEM f I DEDICATED WATER RECYCLE SYSTEM t DISHWASHER s DRINKING FOUNTAIN _ } FOOD DISPOSER 1 { ... --- �.... ._. _ ._ _ ... FLOOR I AREA DRAIN i I { } INTERCEPTOR ((INTERIOR) KITCHEN SINK ` LAVATORY . __.._—._.. _ __. r ROOF DRAIN { I SHOWER STALL l SERVICE 1 MOP SINK TOILET _ .............._.__..._._..._....__..__.........E._.-_........_..,.__..-.._..._.. ......_...._... _. ....._...... .._.........__.._...%..........._.. .._......._._... _I r___...__W... .....URINAL----......-._.._._...__._..._...___._....-._.........__. _._. ... ; .� i i WASHING MACHINE CONNECTION __;_.-_-__�._._ .. __ _.- _ __ ___ WATER HEATER ALL TYPES WATER PIPING . I i OTHER .. __...-...._._...._..._..... _ -.. � _.. # .. __ . ._..._._ .__...._.—___..____.__._. { _ { 1 • _1 - - I i . { INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES vt NO { { IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW { LIABILITY INSURANCE POLICY ii. 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. 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 Sara rue and accurate to the bes f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in a pliance wrwwi h , I e in vision cif the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. " . PLUMBER'S NAME Donald R Mercier LICENSE # 31082 SIGNAT E { MP. JP I' CORPORATION # PARTNERSHIP # LLC # COMPANY NAME Barnstable County Plumbing & Heating ADDRESS 4 Wildwood Way CITY Sandwich STATE MA ZIP 02563 TEL 508-420-5919 FAX CELL 508-420-5919 EMAIL bcph08 c gmail.corn CE v D JUN 07 2021 BUILDiNG DEPARTMENT B y: ---- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORKL CITY YARMOUTH MA DATE June 07,2021 PERMIT# BLDP-21-007080 JOBSITE ADDRESS 22 SYLVAN WAY OWNERS NAME MIRANDA JOSEPH A G OWNER ADDRESS MIRANDA KATHY C 103 KNOB HILL RD MERIDEN CT 06451 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY 0 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 Donald Mercier LICENSE# 31082 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc []# COMPANY NAME: DONALD R MERCIER ADDRESS. 4 WILDWOOD WAY, CITY SANDWICH STATE MA ZIP 025632686 TEL FAX CELL EMAIL bcph08t gmail.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 rti n qk =, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . ',=- C � aa.1.-- ITY South Yarmouth MA DATE 06/071202/ PERMIT # JOBSITE ADDRESS 22 Sylvan Way OWNER'S NAME Joseph MirandaG OWNER ADDRESS Same TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL V PRINT / CLEARLY NEW: RENOVATION: REPLACEMENT: / PLANS SUBMITTED: YES NO N APPLIANCES 1 FLOORS--. Eism { l 2 3 4 d; l h 7 8 9 10 11 12. 13 14 , BOILER i _ — BOOSTER CONVERSION BURNER l i COOK STOVE _........__._....t...._.._ ,......___.__._.,... ..........._..... __ _.__ .._.._ ____ .. _.- _ ......_ DIRECT VENT HEATER � DRYER —____..._.. -- _.._._.._......_ _ _ _ .----. . FIREPLACE .............. ... __w__....... '.._....................E Lf YOLATOR IFURNACE GENERATOR _ .—_ ._._ GRILLE _ ..._.._.............._..............._..._......_ ._. _...__.._l - ___...... . ... . . _.._.._._._._......__ _ -__......__...........__......._....._...... .... — INFRARED HEATER I LABORATORY COCKS 1 i MAKEUP AIR UNIT ! ; OVEN _-_ __ _ ,__ -POOL HEATER # --t R00M I SPACE HEATER I I i I ROOF TOP UNIT TEST UNITHEATER �._....... ........ I �.. �....._..........._......._.... __ _.. MUNVENTED ROOM HEATER WATER HEATER F i i OTHER l F F i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I 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 to the best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c• • iance with all ertine ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws PLUMBER-GASFITTER NAME Donald R Mercier LICENSE # 31082 SIGNAT E MP MGF JP V JGF LPG! CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: Barnstable County Plumbing & Heating ADDRESS 4 Wildwood Way CITY Sandwich STATE MA ZIP 02563 TEL 508-420-5919 FAX CELL 508-420-5919 EMAIL bcph08'agmail.c©m ..w....__ _ _- _ ..__ .- . . ___. _._ _ _.._ _ .._._. ._ _..__ _....____._...w_._.________ - .