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HomeMy WebLinkAboutBLDP&G-20-005834 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y Ga CITY YARMOUTH MA DATE 5/14/20 PERMIT# BLDP-20-005834 11 JOBSITE ADDRESS 241 WILLOW ST OWNER'S NAME BIO-MEDICAL APPLICATIONS OF CAPE COD INC P OWNER ADDRESS CIO FMC 1112 ONE WESTBROOK CTR STE 1000 WESTCHESTER, IL 60154 -FI TYPE OR OCCUPANCY TYPE COMMERCIAL n RESIDENTIAL n PRINT CLEARLY NEW:n RENOVATION:[ REPLACEMENT:71 PLANS SUBMITTED: YES[ NOI FIXTURES -i 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 i 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. YESE1 NO n IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYn OTHER TYPE OF INDEMNITYn BONDn 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 EDWARD PHELAN LICENSE10073 SIGNATURE MP n JP n CORPORATION I it PARTNERSHIP ET LLC COMPANY NAME ADDRESS 931 TURNPIKE ST J CITY N.ANDOVER STATE MA ZIP 01845 TEL 9786214103 FAX CELL EMAIL /?(y7 �� r/5- r � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK_ ' CITY YARMOUTH MA DATE May 14, 2020 5ERMIT# BLDP-20-005834 i ,ma ; JOBSITE ADDRESS 241 WILLOW ST OWNER'S NAME BIO-MEDICAL APPLICATIONS OF CAPE COD IN G OWNER ADDRESS C/O FMC 1112 ONE WESTBROOK CTR STE 1000 WESTCHESTER IL 60154 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Ei RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:Q 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 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 Q NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 EDWARD PHELAN _ICENSE# 10073 SIGNATURE MP0 MGF❑ JPE JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. 931 TURNPIKE ST, CITY N.ANDOVER STATE MA SIP 01845 TEL 9786214103 FAX CELL EMAIL G/e /7z--