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Home My WebLink AboutBLDP&G-19-005930 ', MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK tss �� ' CITY[Yarmouth I MA DATE 4/12/19 ;PERMIT#J !'/F-OO 3—'716 ayM1_. JOBSITE ADDRESS 2 Seminole Dr OWNER'S NAME,Oldham I POWNER ADDRESS 2 Seminole Dr TELE8-362-3905 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL 0 PRINT CLEARLY NEW: J RENOVATION:� REPLACEMENT:!�1 PLANS SUBMITTED: YES NOQ FIXTURES 1 FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 11— 1 I CROSS CONNECTION DEVICE 41 -II _ i J DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM L _ ' DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM IT DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN L- INTERCEPTOR(INTERIOR) E KITCHEN SINK LAVATORY ROOF DRAIN v,,' SHOWER STALL SERVICE/MOP SINK TOILET IAisio, ---11 URINAL IL WASHING MACHINE CONNECTION in WATER HEATER ALL TYPES L 1 WATER PIPING L„ OTHER t!- .limmimmimmoz INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES....i7J NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ld OTHER TYPE OF INDEMNITY 0 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 t 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 t rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L /ci--_ ��- PLUMBER'S NAME JAMES CARABITSES —"LICENSE# 11156 SIGNATURE MP JP CORPORATION El# 3759 PARTNERSHIP❑# LLC❑# COMPANY NAME ARS BOSTON l ADDRESS 1300 MANLEY STREET I CITY WEST BRIDGEWATER STATE MA ZIP F02379 TEL 508 588 9025 I FAX 508-558-1059 I CELL EMAIL I . I 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 "ems ‘Viiiiri.: CITY Yarmouth MA DATED/12/19 PERMIT#/•41) 60J l JOBSITE ADDRESS 2 Seminole Dr 'OWNER'S NAME Oldham I GOWNER ADDRESS 2 Seminole Dr I TEL 508-362-3905 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:Ej PLANS SUBMITTED: YES Li NOLI APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER -in-" COOK STOVE DIRECT VENT HEATER _ DRYER _. FIREPLACE .�.. FRYOLATOR �..ILm. .�. —IL FURNACE .. ill[-, GENERATOR .. GRILLE INFRARED HEATER . LABORATORY COCKS MAKEUP AIR UNIT OVEN . POOL HEATER ROOM/SPACE HEATER fir_ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATERr— WATER HEATER 1 OTHER 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES i NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I i j OTHER TYPE INDEMNITY LI_ I BOND Li x 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 L 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 Perlin ritprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , .K c' //.64- PLUMBER-GASFITTER NAME James Carabitses LICENSE# 11156 I z SIGNATURE MP El MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION Q# 3759 PARTNERSHIP❑# Lc❑# COMPANY NAME: ARS Boston ADDRESS r 300 Manley Street I CITY LW.Bridgewater I STATE MA ZIP 02379 —ITEL 508-588-9025 FAX 508-588-1059 CELLI 'EMAIL ,.._rCJ 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