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HomeMy WebLinkAboutBLDP&G-22-006290 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK viv_4 CITY YARMOUTH MA DATE 5/2/22 PERMIT# BLDP-22-006290 �, JOBSITE ADDRESS 37 REID AVE OWNER'S NAME ALBERGHINI ANTHONY L P OWNER ADDRESS ALBERGHINI SUSAN L 56 LITTLE POND NORTHBOROUGH,MA 01532 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES • FLOORS-u 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 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 Mark Moniz LICENSE 30307 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK AMONIZ ADDRESS 14 KNOLLWOOD DR CITY E FALMOUTH STATE MA 1 ZIP 025367225 TEL FAX CELL EMAIL monizplumbing@comcasi.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ rt FEES E PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY c,, MA DATE : IC? Z- PERMIT #_ 2- (iv `16 JOBSITE ADDRESS 37 Rcek_ Ave__ OWNER'S NAME /2,f/to n 4/J ( (' 1 1 ,\ i OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E RESIDENTIAL-1c PRINT CLEARLY NEW: • RENOVATION: El REPLACEMENT) PLANS SUBMITTED: YES NO FIXTURES 7 FLOOR-4 BSM 1 2 i 3 4 5 6 `^ 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 WATER PIPING OTHER - --- - --�-. L Li ---. INSURANCE COVERAGE: I have a current Iiability_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 ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c- PLUMBER'S NAME Mark Moniz LICENSE # 30307 r SIGNATURE MP JP v CORPORATION # PARTNERSHIP # LLC f # COMPANY NAME Moniz & Son Plumbing ADDRESS 14 Knollwood Dr. CITY Falmouth STATE MA ZIP 02536 m s TEL 508 280 3966 FAX CELL EMAIL Monizplumbing@comcast.net 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 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 91' CITY IYARMOUTH MA DATE 'May 02,2022 I PERMIT# BLDP-22-006290 JOBSITE ADDRESS 37 REID AVE OWNERS NAME ALBERGHINI ANTHONY L G OWNER ADDRESS ALBERGHINI SUSAN L 56 LITTLE POND NORTHBOROUGH MA 01532 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q 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 0 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 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 Mark Moniz LICENSE# 30307 SIGNATURE MP 0 MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑#f LLC❑# COMPANY NAME: MARK A MONIZ ADDRESS. 14 KNOLLWOOD DR, CITY E FALMOUTH STATE MA ZIP 025367225 TEL FAX I CELL j EMAIL monizplumbing4comcast.net S310N M3I/01:1 NVld #II1/0:13d $:33d ❑ ❑ 1111183d 3E41 SY S3A83S NOLLV3llddV SIHJ oN seA S31ON NO1103dSNI lYNI3 1lN0 3Sl d0103dSNI bO 130\fd SIH1 S310N NOI103dSNI SYO HJfO J • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "berry CITY tiet,C inA.o :-12tt9_. MA DATE 5- ,/ Z. 7ZCZPERMIT # ZZ' L2 Z ` L JOBSITE ADDRESS 3-7 f3'r OWNER'S NAME /1 - ); 6 c.'1 A l�r;° t. ,1%, v,\ OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL :D RESIDENTIAL ' PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YES NO APPLIANCES - FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER 1 COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR ��— FURNACE GENERATOR - ---- GRILLE INFRARED HEATER _ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER OTHER . . .,v_ . INSURANCE COVERAGE I have a current Iiabilityinsurance 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 and accurate to the best of my knowledge and that all plumbing wo-k and installations performed under the permit issued for this application will be in compliance with all Pertinent provise of t Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t� / PLUMBER-GASFITTER NAME Mark Moniz LICENSE # 30307 SIG RE MP ,,,,,J MGF JP L. JGF J LPG' El CORPORATION #L.__ PARTNERSHIP # LC # COMPANY NAME: Moniz &Son Plumbing ADDRESS 14 Knollwood Dr. CITY Falmouth j STATE MA JZIP 02536 TEL 508 280 3966 FAX CELL EMAIL monizplumbing@comcast.net