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HomeMy WebLinkAboutBLDP&G-18-006833 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/4/18 PERMIT# BLDP-18-006833 ATO JOBSITE ADDRESS 126 PARKWOOD RD OWNER'S NAME LUCEY CHRISTOPHER P OWNER ADDRESS EARLY KEVIN W TR&SHIELA W 94 FENNO ST REVERE, MA 02151 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YESD NO El 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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'S NAME Richard Whiteside LICENSE*5850 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD J WHITESIDE ADDRESS 29 MAPLE TER CITY SOUTH DENNIS STATE MA ZIP 026603651 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ DGDRAIT FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 04, 2018 PERMIT# BLDP-18-006833 JOBSITE ADDRESS 26 PARKWOOD RD OWNER'S NAME LUCEY CHRISTOPHER G OWNER ADDRESS [EARLY KEVIN W TR&SHIELA W 94 FENNO ST REVERE MA 02151 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 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 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 Richard Whiteside LICENSE# 15850 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: RICHARD J WHITESIDE ADDRESS 29 MAPLE TER, CITY SOUTH DENNIS STATE MA ZIP 026603651 TEL FAX CELL EMAIL SALON M2IA2H NV1d #lIW2�3d $ :33d El El 1I1/213d 3H1 SV S3A213S NOIlVOf lddV SIHl oN seA S�lON NOIIOAdSNI 1VNIJ .LINO Sfl HO1O�dSNI HOi AO`dd SIHl S3LON NOLLOadSNI SVO HJfO2i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ems= k CITY SOUTH YARMOUTH MA DATE 5/24/18 PERMIT#,31✓nb-nr-6Vl� 1j JOBSITE ADDRESS 29 PARKWOOD AVE OWNER'S NAME CHRIS LUCEY OWNER ADDRESS 96 FENNO STREET REVERE,MA„02151 TEL 617-549-4807 FAX, __ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL'A PRINT PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: _ PLANS SUBMITTED: YES . NO- '.. APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER [ BOOSTER I CONVERSION BURNER E COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR 1 .,,,;,,, 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 1 j WATER HEATER 1:. y:: j OTHER 11 f INSURANCE COVE" RAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES u. .,NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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. CHEC it.NE ONLY: OWNER AGENT -7.3 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application .e an. ac • e to the bes knowledge and that all plumbing work and installations performed under the permit issued for this application will be i • ilia - ' h all Pe provisi,n of the II Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,. PLUMBER-GASFITTER NAME Richard J.Whiteside LICENSE# 15850 SIGNATURE MP , MGF JP JGF LPGI j CORPORATION_J# 3969 PART -SHIP' # ' LLC Tj# COMPANY NAME: Murph Services Inc 'ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 $TEL i 508-760-1660 3 FAX 508-760-1670 # h ll h // klb ll h CELL EMAIL csea@camurpys.com aue@camurpys.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