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Home My WebLink AboutBLDP&G-24-852 , . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ s_ CITY Yarmouth oral — MA DATE 9/30/2024 I PERMIT# %ib( 1- 8 i!i 2 JOBSITE ADDRESS [13 Oak Glen, Yarmouth Port jj OWNER'S NAME Denise Meiners I P OWNER ADDRESS Same I TEL 5087376076 FAX I I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL Li RESIDENTIAL Li PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES NO0 FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB — CROSS CONNECTION DEVICE ;OM 1111111111111111f DEDICATED SPECIAL WASTE SYSTEM r— r DEDICATED GAS/OIL/SAND SYSTEM ` „ff' [ x- DEDICATED GREASE SYSTEM _ - R? DEDICATED GRAY WATER SYSTEM ii, y ____ DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ DRINKING FOUNTAIN 1 in— 011il FOOD DISPOSER 01.111111111111.111111111 - -_ FLOOR I AREA DRAIN L �I� INTERCEPTOR(INTERIOR) _ _ — - KITCHEN SINK LAVATORY ROOF DRAIN111 _ SHOWER STALL SERVICE/MOP SINK TOILET URINAL Inn WASHING MACHINE CONNECTION IIIIIIMM ®__®®____.._____._. WATER HEATER ALL TYPES ■ ii ®®__.__ •® - WATER PIPING E-111111 OTHER iiiiiiiiiiirsaLinEll_ 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 i 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 [ 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 ac u e to th of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli with all Pe ' visio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Michael J.Maille 'LICENSE# 11355 I f AT E MP i JP❑ CORPORATION❑# PARTNERSHIP❑# i LLCQ# 3609 COMPANY NAME Homeserve USA Energy Services NE LLC I ADDRESS 5B Constitution Way CITY Woburn I STATE MA ZIP 101801 1 TEL 1781-359-2606 ` FAX CELL L 1 EMAIL trachel.whittick@homeserveusa.com J ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE 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 le;Iiiiitm +Itli� . CITY Yarmouth c MA DATE 9/30/2024 PERMIT# JOBSITE ADDRESS 13 Oak Glen, Yarmouth Port OWNER'S NAME Denise Meiners GOWNER ADDRESS Same TEL 5087376076 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:[J PLANS SUBMITTED: YES© NO APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i --i —i 3 If BOOSTER 1 CONVERSION BURNER r--- 1COOK STOVE _ 1.111111 _ DIRECT DRYER VENT HEATER ��' 1111111,111111l 11111110111.11 FIREPLACE ..i . a _1 MI MINI FRYOLATOR1 I 1 l i l 1 11 ' FURNACE i � GENERATOR 1 GRILLE INFRARED HEATER � � =j��'�� LABORATORY COCKS i ',MX NM MAKEOVENUP AIR UNIT — t _ ' POOL HEATER ROOM/SPACE HEATER ! ' nu ROOF TOP UNIT I��'Mg �- TEST � _ - ,-_ _ . UNIT HEATER 1 t �� UNVENTED ROOM HEATER WATER HEATER 1 - _ _ _ i —� OTHER 1 —1 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY U BOND Q 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: OWN AGENT ij 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 an curate to t es f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' ce with all P r vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Michael J. Maille LICENSE# 11355 J SIGNATURE MP Li MGF❑ JP 0 JGF❑ LPG'❑ CORPORATION❑# PARTNERSHIP❑# I LLC Q# 3609 COMPANY NAME:HomeServe USA Energy Services,NE,4 ADDRESS 5 Constitution Way CITY Woburn STATE MA ZIP 01801, TEL 781-359-2606 FAX CELL EMAIL Rachel.whittick@homeserveusa.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 1 '