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Home My WebLink AboutBLDP&G-20-004969 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK a_ r ;j1== CITY Yarmouth �_ MA DATE 02/25/2020 PERMIT /7 /--o-a)Cl/Xi JOBSITE ADDRESS 107 Jefferson Avenue,West Yarmouth OWNER'S NAME Dave Erickson POWNER ADDRESS 107 Jefferson Avenue,West Yarmouth TEL 508-726-4810 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL Li RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:Q REPLACEMENT:iv PLANS SUBMITTED: YES i I NO FIXTURES Z FLOOR-1 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB pIn 1111111 CROSS CONNECTION DEVICE 0[— �: i, DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM i DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ....§§4 FLOOR/AREA DRAIN Op ll INTERCEPTOR(INTERIOR) KITCHEN SINK i LAVATORYp 1 ; ROOF DRAIN l SHOWER STALL SERVICE/MOP SINK TOILET URINAL 711191 WASHING MACHINE CONNECTION IM71.1 ,_1 WATER HEATER ALL TYPESr______ ,,,,,,__ .,„., WATER PIPING OTHER.. 7.7IR ER 1! P I.! _ ._. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES j ' NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I v 1 OTHER TYPE OF INDEMNITY 1 BOND P1 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 El 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 Kevin J.Sullivan LICENSE# 13041 SIGNATURE MP JP❑ CORPORATION D#12.4D PARTNERSHIP f# LLC I l# COMPANY NAME[ Ready Rooter, Inc. ADDRESS P.O.Box 371 CITY Sandwich STATE MA ZIP 02563 TEL 508-888-6055 FAX 508-888-0242 CELL EMAIL kjs@a readyrooter.com I _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • 4.4l CITY Yarmouth MA DATE 02/25/2020 PERMIT#/ /7fr 2-Cn�/ JOBSITE ADDRESS 107 Jefferson Avenue,West Yarmouth OWNER'S NAME Dave Erickson OWNER ADDRESS 107 Jefferson Avenue,West Yarmouth TEL 508 726 4810 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL,_ EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: . REPLACEMENT: � PLANS SUBMITTED: YES - NO APPLIANCES Z 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 L, FIREPLACE l , 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 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 U 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 in compliance with all Pertin rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Kevin J.Sullivan LICENSE#. 13041 NATURE MP 0 MGF❑ JP[J JGF L IJ LPG' CORPORATION #L 2433 PARTNERSHIP j, tt LLC ,�# COMPANY NAME: Ready Rooter,Inc. I ADDRESS P.O. Box 371 CITY Sandwich I STATE r, MA ZIP 02563 TEL 508-888-6055 j .._.._.,..... ............E FAX{508-888-0242 CELL EMAIL kjs@readyrooter.com i L/P#