No preview available
HomeMy WebLinkAboutBLDP&G-22-007490 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k,ri,1 rb CITY YARMOUTH MA DATE June 29,2022 PERMIT# BLDP-22-007490 Fl JOBSITE ADDRESS 21 RITA AVE OWNER'S NAME Edward Mooers G OWNER ADDRESS 21 RITA AVE SOUTH YARMOUTH MA 02664-1978 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO ❑ 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 —rt 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 Ralph Giangregorio LICENSE# 9339 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# ] COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE IMA I ZIP 102639 I TEL I ] FAX CELL EMAIL Iofficean3gsplumbinq.net 1 S310N M3IA3b NVlld #±IW213d $ :333 1111213d 3H1 SV S3A213S NOLLV3llddd SIH1 oN saA S310N NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 2i0d 3OVd SIHI S31ON NOI103dSNI SVO HOflO I k �.-.• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I 5 MA DATET 57 1 PERMIT# 2 — -1,1 R c, JOBSITE ADDRESS _ _.._I OWNER'S NAME[f'Ynx(-)`1y GOWNER ADDRESS fa '1�canYe✓S [ : 7,0f�(l�S_ TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL Li RESIDENTIAL1( PRINT CLEARLY NEW:0 RENOVATION:LI REPLACEMENT:IB PLANS SUBMITTED: YES[J NOkeT� APPLIANCES 1 FLOORS-1 9SM 1 2 3 4 5 6 7 8 9 I 10 11 i2 13 14 BOILER ----- BOOSTER — MIIIM JIMNM 1 _ DIRECTI 'iiimi `II . ..._.lidn�A—a' l 111 imps .ii11Jfl —,' ici DRYER MINI110.1111111111M.01111111.010111.1•1111WIli;1110,-- FRYOLATOR put i [eigri i— i [ 11 ll�l [1.1 i l l l il_l FURNACE ac MITIPAMMIMPIMina GRILLE 1ir1;r 1.ld�_ Alit Ii I1 INFRARED I- �I VW,„_-_ • : $===i=*=z11 POOL HEATER 111111.11111.211.11111011-1101.1.11101011111.1111111101111111101111011 ROOM!SPACE HEATER ' M.; j, T j ROOF TOP UNIT :. .11 1 1 11 y 1 1 1( TEST XIM - UNIT HEATERF 11 UNVENTED ROOM HEATER „ WATER HEATER! OTHER _.. __ Il �1 W, 1N{ � _ -!�—'tli ..,,..,..�. —l#>�IMII(1A�1 i--—I_II ICI l 11 .1111.`�I i , ;ill fIII.. 1 ,, ._.•-.rm��»�u.,.,... -' ea - -._ ....avu ,r, ... „r-...,a... ,..,, . ......,....... .,,.rt-.,..,r 3.+....m..:,'I«,.,,_�I....,....::_. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES NO ri I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I2r OTHER TYPE INDEMNITY BOND L 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 Li AGENT Li SIGNATURE OF OWNER OR AGENT t 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ems' PLUMBER-GASFITTER NAME n _ c),4 t V LICENSE#(' < j j SIGNAT E- MP 10 MGF D JP® JGF® LPG!❑ CORPORATION®#1311'O G PARTNERSHIP[ 7#=.=LLC COMPANY NAME: jG;S .����,- c,Ur� I STATE J ZIP v Z , . �— CITY �c.t/.lJ1J A.))07 ,�._ ;�:.. - FAX �q b%? CELL EMAIL • P,lG — ►�► JUN 291011 eYUIL`pEPgRTMENT MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK as t_�(x CITY YARMOUTH MA DATE 6/29/22 PERMIT# BLDP-22-007490 I - 'TA ` JOBSITE ADDRESS 21 RITA AVE OWNERS NAME Edward Mooers P OWNER ADDRESS 21 RITA AVE SOUTH YARMOUTH,MA 02664-1978 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑v PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:CJ PLANS SUBMITTED: YES NO❑ FIXTURFS • FLOORS BSM 1 2 , 3 , 4 5 6 7 8 9 10 11 12 13 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❑ 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 Ralph Giangregorio LICENSE 91339 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# _ LLC ❑# COMPANY NAME RALPH J GIANGREGORIO ADDRESS 188 Route 28 CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL EMAIL office@3gsplumbing.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES / 1AP : p P C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i- CITY I(t�f1 �lsl)\ MA DATE (..a PERMIT# Lz— ..-I1 `) JOBSITE ADDRESS L( i\ 4cL I Cart-L' OWNER'S NAME MCA yi ik j ti fCO P P OWNER ADDRESS I Da \W Qt (Art - 5, I)CAr11L TELr I1 -(rCl7' ic)FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0- PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Qr PLANS SUBMITTED: YES El NO; FIXTURES Z 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/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 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 Er NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY ® OTHER TYPE OF INDEMNITY 0 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 of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be inernpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r,krk �-i'c' - ,�� r LICENSE# 3cI SIGNA E MP;I JP❑ CORPORATION®#iletu C PARTNERSHIP❑# LLC❑# COMPANY NAME -$ Flu,-.6;\i'Yo �- WeC 1�c , ADDRESS I 5-Cs" CITY .tPd)/l i S Par'f- STATE 6i ZIP (7)96 3 cl TEL I FAX_�� � �c 4�� CELL EMAIL Q',— ( ' j r1b'vkliD"' , 11.0