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HomeMy WebLinkAboutBLDP&G-23-006118 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK L,v CITY YARMOUTH MA DATE 515/23 PERMIT# BLDP-23-006118 JOBSITE ADDRESS 113 MULFORD ST OWNERS NAME FREIDMAN NEAL • P OWNER ADDRESS ARONIS FRIEDMAN GALINA 111 SOUTH ST BROOKLINE 02467-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES l 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. SIGNATURE OF OWNER OR AGENT 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 keih farnham LICENSE 111601 SIGNATURE MP CO JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SOUTH SHORE HEATING ADDRESS 57 whites path CCtOI INC; CITY south yarmouth SIAIE MA ZIP 02664 TEL 5083986901 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW.FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK eig—`-�`= CITY So t� h '/a t' 1 D L 1 MA DATE 5I� PERM!� ��P Z j�U� G���r JOBSITE ADDRESS 113 MLAI4 JT • OWNER'S NAME t1.4Q1 cc-IC.6111( \ OWNER ADDRESS 'CL. YL:ft_ TELco(-45643a-- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[r PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES❑ NO ErP 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN `' SHOWER STALL V SERVICE/MOP SINK e TOILET URINAL WASHING MACHINE CONNECTION Vgi WATER HEATER ALL TYPES tjo,A R t =N WATER PIPING 1LDtNC' OTHER yyU 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 TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 0 AGENT- SIGNATURE OF OWNER OR AGENT y I hereby certify that all of the details and information I have submitted or entered regarding this application are true and urat o knowledge, and that all plumbing work and installations performed under the permit issued for this application will be in complian h all e ovi • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER'S NAME Ke t`}-41 j-txy-n ham LICENSE# <<(DD NATURE MP[ JP❑ CORPORATION[f#30$C PARTNERSHIP❑# LLC❑# COMPANY NAME c5Du.NPU1 J114M.Q_ALA t r1S.Loot Inns ADDRESS 51 u.* CITY S - T tt-Ahi10 Ll�� STATE MA ZIP a WS TEL 5D$391690(D9D FAX CELL EMAIL C1e 50t.t`i►i'1511oce I'1Q4ktY 9C 11 Coll MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "" "�'F' CITY YARMOUTH MA DATE May 05,2023 1PERMIT# BLDP-23-006118 JOBSITE ADDRESS 113 MULFORD ST OWNERS NAME FREIDMAN NEAL G OWNER ADDRESS ARONIS FRIEDMAN GALINA 111 SOUTH ST BROOKLINE 02467-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY El BOND 0 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 keih famham LICENSE# 11601 SIGNATURE MP❑MGF❑JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# JLLC❑# COMPANY NAME SOUTH SHORE HEATING COOLING ADDRESS. 57 whites path, CITY south varmouth STATE MA ZIP 02664 TEL 15083986901 FAX CELL EMAIL 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ( CITY: Sot+�� 7�L1 �'10�1 MA. DATE: 51.;-• PERTviff# JOBSITE ADDRESS: 113 rn t,A t'f ocd 3I1• OWNER'S NAME: meal G I ..r)ry aY' GOWNER ADDRESS: TEL:(-D 1-4•5-(5.4-3ag-FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[3 CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Et/ PLANS SUBMITTED: YES❑ NO[►� APPLIANCES-1 FLOOR Bsmt 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - 'FRYOLATOR FURNACE GENERATOR GRILLE V} INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER �I ROOM/SPACE HEATER E C E 0 Y E 0` ,.{ ROOF TOP UNIT --_.— -..._ i $ TEST UNIT HEATER _ MAY 05 28 a 14j UNVENTED ROOM HEATER I L 1 WATER HEATER I RLJLLDING DLPARTMENT j - - ../ ) . INSURANCE COVERAGE / I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E NO ❑ If you have checked YES,please Indicate the type of covera e 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and a rat to the bias* y Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in plia ertin t provision of the Massachusetts Stattee..Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: SE l .*" 4CZr,n haYYl _LICENSE# 11601 `SIGN RE COMPANY NAM EiOtt,4� `n JUL u�' \Y� ADDRESS: .5 Lh 5 PQJCY-\ CITY i,..5.`-C -f' 1t,t,t 'I'N STATE: H A ZIP: C a C0 L0 ti FAX: TEL:50S39$(,4)CA CELL: EMAIL: b. d. runt. Q 5ot.�`1,N5.1ocC612 oak tool Irs. c MASTER[7 JOURNEYMAN❑ LP INSTALLER❑ CORPORATION Q 1f 3toqg C PARTNERSHIP❑# _ LLC❑# c hmy 4_, ADDrz c ss