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HomeMy WebLinkAboutBLDP&G-22-004815 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w,mr CITY YARMOUTH MA DATE 3/1/22 PERMIT# BLDP-22-004815 rI JOBSITE ADDRESS 115 ROUTE 6A OWNER'S NAME TEAGUE EDWARD B P OWNER ADDRESS TEAGUE KATHLEEN J 115 MAIN ST YARMOUTH PORT,MA 02675-1709 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—r 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 RECYGLE 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❑ 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'S NAME Paul Kelly LICENSE' 689 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PAUL J KELLY ADDRESS 70 SHOREWOOD DR CITY MASHPEE STATE MA ZIP 026492817 TEL FAX CELL EMAIL paul@kellyph.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -4__�:•- I �ICI�Y 4 iv !f-' - � �- MA DATE / 2-2_ PERMIT# MiSO O BSI`E f DDRESS it c /i iu i L, j k OWNERS NAME ,z r, OWNER ADDRESS TEL fAX :UILDING uLHAKTM: NT WPE OR QCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:3----- PLANS SUBMITTED: YES❑ NO❑ FIXTURES T FLOOR-4 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 -1 DEDICATED WATER RECYCLE SYSTEM DISHWASHER I _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN r _ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN y SHOWER STALL i SERVICE/MOP SINK TOILET URINAL 1 j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER II li INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El/NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THETY-E 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 i 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�i 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 LICENSE# %/Lff . / SIGNATURE MP'JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME 6(fl ADDRESS CITY 'if Oa- STATE J 11, ' ZIP 0-2 (71'5 TEL --'0Y ' ! °1 Z FAX CELL .`-fd EMAIL X,/ ,4//,pui • vt'2f 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 `� r L' — � v E ry SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �' -� =i`'— CITY r PLO-4-4 ,/�-- M 1 ��,�^ 6 r_ MA DATE "1 L Z PERMIT L� E ADDRESS 1/.S 1/44i K ./ S OWNER'S NAME__._,(.z k�, � :UILDÔA DRESS Y -.. _ TEL FAX PRINT OCCUPANCY TYPE COMMERCIAL ElEDUCATIONALCLEARLY ❑ RESIDENTIAL El NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO 0 APPLIANCES FLOORS SSM 1 2 3 15 F o BOILER 9 to 1I 12 13 L BOOSTER CONVERSION BURNER �—__ COOK STOVE DIRECT VENT HEATER - DRYER —'-- FIREPLACE - _ , FRYOLATOR i FURNACE GENERATOR. GRILLE ---1- INFRARED HEATER —~ LABORATORY COCKS MAKEUP AIR UNIT • OVEN POOL HEATER • ROOM I SPACE HEATER ---�—_ ROOF TOP UNIT —'— TEST UNIT HEATER r-- UNVEIJTED ROOM HEATER WATER HEATER _ OTHERI �-- INSURANCE COVE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES qqLINO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW u "W 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, • SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT 0 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 myknowledge `- 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. Lo L�� PLUMBER GASFITTER NAME )V ,�/ LICENSE# �� 0' SIGNATURE MP Mc'F❑ JP ❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP 0# ftC COMPANY NAME t- ADDRESS CITY f�L v STATE MR ZIP_ 6 7 TEL 1(2)4- FAX CELL w EMAIL �i✓�_ 1 , INSPECTI -NO ESS THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES ROUGH Yes THIS APPLICATION SERVES AS THE PERMIT (� n FEE: $ PERMIT it PLAN REVIEW NOTES