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HomeMy WebLinkAboutBLDP&G-23-001277 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u �a CITY YARMOUTH MA DATE 9/9/22 PERMIT# BLDP-23-001277 - {/`J JOBSITE ADDRESS 17 MEADOWBROOK RD OWNER'S NAME JOHNSON ERIC P OWNER ADDRESS 17 MEADOWBROOK RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 BOND❑ OWNERS 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-egarding 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 Joseph Lemieux LICENSE 1A791 SIGNATURE • MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME JOSEPH S LEMIEUX ADDRESS 18 DINAHS WAY CITY WAREHAM STATE MA ZIP 025711463 TEL FAX CELL 6173068360 EMAIL js.lemsons@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMITH PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` a= or, ,t, .. ,,,,, CITY [YARMOUTH MA DATE September 09, 202 PERMIT# BLDP-23-001277 `5s,' JOBSITE ADDRESS 117 MEADOWBROOK RD OWNER'S NAME JOHNSON ERIC G OWNER ADDRESS 17 MEADOWBROOK RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID 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 p umbing 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 Joseph Lemieux LICENSE # 10791 SIGNATURE MP © MGF El JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC El # COMPANY NAME: JOSEPH S LEMIEUX ADDRESS. ,18 DINAHS WAY, CITY WAREHAM STATE MA ZIP 025711463 TEL FAX CELL 6173068360 EMAIL is.lemsorsna yahoo.com S310N M3I/\3d NV1d #LMW2i3d $ 33d El 0 11INH3d 3H1 SV S3A2J3S NOIlV0IlddV SIH1 oN saA S310N N01103dSNI 1VNId A1N0 3Sl 210103dSNI HOd 30Vd SIH1 S310N N01103dSNI SVO HOl0H 40 ?ti' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PE ORM GAS FITTING WORK t 1— CITY: l C�2,6^ MA. DATE PERMIT#Z j 12 7'7 4 -J JOBSI A E DDRESS: /9 Z r7-1 OWNER'S NAME 1", /C 1' C. lJ G OWNER ADDRESS:`J/ L/ik.,-`4- <( TEL: FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL D' �, CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:Q/ PLANS SUBMITTED: YES❑ NO 0 N ' �APPLIANCES1 FLOOR-' Bsmt 1 2 3 _ 4 5 6 7 8 9 10 11 12 13 14 ,0 BOILER BOOSTER 'v CONVERSION BURNER V1 COOK STOVE a DIRECT VENT HEATER ✓ DRYER FIREPLACE _ _ `n FRYOLATOR ' FURNACE _ GENERATOR GRILLE !A INFRARED HEATER W LABORATORY COCK _ _ MAKEUP AIR UNIT c OVEN POOL HEATER ROOM I SPACE HEATER ..I ROOF TOP UNIT ' TEST UNIT HEATER tti UNVENTED ROOM HEATER WATER HEATER / r • INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 ❑ If you have checked YES,please indicate the type of coverage b eig the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND 0 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this apphcalion are tru -- of my Knowledge and that all plumbing wort and installations performed under the permit issued for this application be all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASF TTER NAME: ,'�c s ,evJo LICENSE# /GJ/% , SIGNATURE COMPANY NAME: J•S 2 c.'✓l1&C L11� d a4 (i). DRESS: i 0 D r., 6. CITY:`j) 1 -'-re t STATE/ ZIP: e 7‘ FAX TEL:=%e ) ', /`111.2 CELL: I>/-30‘ "63ie 63,4AIL: JS - c i—t 5 S (t- 74,AZ,G- 1-1--- MASTER fr.5-OURNEYMAN 0 LP INSTALLER❑ CORPORATION • PARTNERSHIP 0# LLC 0# ch ,- DzIXLES : f . 1e/n � 5 5i 6-y L A eA ,-4)_.c',+, z a 0 W • ,* 2 e CL -J W w a ▪ M N Li! F W W • a 4.4