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Home My WebLink AboutBLDP&G-18-003874 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK MC! As- s"F� _ CITY Yarmouth MA DATE 01/08/2018 Ji PERMIT# 9711� �� z/71 JOBSITE ADDRESS 57 Town Brook Rd Unit B OWNER'S NAME Josh Bell OWNER ADDRESS Same TEL ;FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES 1 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/OIL/SAND 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 1 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 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. 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 in compli with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f�G PLUMBER'S NAME JASON DREW LICENSE# J-30715 - SIGNATURE MP JP CORPORATION # PARTNERSHIP # LLC # COMPANY NAME DREVV'S PLUMBING ADDRESS 6 AGASSIZ ST CITY BREWSTER STATE MA ZIP 102631 TEL 508-360-1400 FAX CELL EMAIL L � 4 l Y • • 4, it T �,i • • r . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tin— " =; CITY Yarmouth MA DATE 01/08/2018 PERMIT#/ -/r'/' 92IN • JOBSITE ADDRESS 57 Town Brook Rd Unit B OWNER'S NAME Josh Bell GOWNER ADDRESS Same TEL 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 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 l I l I 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 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 an urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JASON DREW LICENSE# J-30715 SIGNATURE MP MGF JP JGF LPG! CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: DREWS PLUMBING ADDRESS 6 AGASSIZ ST CITY BREWSTER STATE MA ZIP 02631 TEL 508-360-1400 FAX CELL EMAIL ��t� 'TPA _ 11t 1,. i J�� • tt••k .1<9'i 1 i`i:` - r.E ; i_' I t r �,- t, .. q t }4 r Y U:ri >� I. V `T 3 ' :. f ... 2,i;3E t ;"-11 , ti. i IL .`ri i •• r i * _ , . r, t.t. t 1, , rr _, 1-,t} wftt`1S?ti s'1tl c-iE# rl3Ctt!1 L. t. t!t ' ae'',.: _„ ti tyro•. h ! �� - . _. ..,. Yam.^a..`.kc7 SK t:�1+�_, ')(' 'fl i i v. r f.: . •-:"t - 6... ;;,_ :a,- r, _ - „--i• y^. _ 1 i t-1. r Jid .._:t.,t, 4t#t4()RA ,.: ,i1t:,..Iya 1;:r9I I