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HomeMy WebLinkAboutBLDP&G-22-001431 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/13/21 PERMIT# BLDP-22-001431 = `' JOBSITE ADDRESS 431 ROUTE 6A OWNER'S NAME OHEARN THOMAS R P OWNER ADDRESS HOLLAND-OHEARN MARYBETH 431 ROUTE 6A YARMOUTH PORT,MA 02675 TEL 182 TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES NO El FIXTURFS -1 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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. 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 Albert Cassano LICENSE 9015 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Cape Cod Mechanical Systems,Inc. ADDRESS 8 Fruean Way CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX CELL 5087769536 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k_ `;e \t: CITY YARMOUTH MA DATE September 13, 202 PERMIT # BLDP-22-001431 VI t sfyr JOBSITE ADDRESS 431 ROUTE 6A OWNER'S NAME OHEARN THOMAS R G OWNER ADDRESS HOLLAND-OHEARN MARYBETH 431 ROUTE 6A YARMOUTH PORT MA 02675 182 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO El 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 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 plurrbing 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 Albert Cassano LICENSE # 9015 SIGNATURE MP ❑ MGF ❑ JP El JGF ❑ LPG! 0 CORPORATION ❑ # PARTNERSHIP ❑ # LLC 0 # COMPANY NAME: Eape Cod Mechanical Systems, Inc. ADDRESS. 8 Fruean Way, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX ] CELL 5087769536 EMAIL S310N M3IA3a NVId #LRN 3d $ 33d ❑ ❑ 111N213d 31-11 SV S3A213S NOI1V31lddV SI1-11 ON SOA S3 LON NO11O3dSNI TVNH A1NO 3Sfl 210133dSNI HOd 30Vd SIHl S31ON NO1133dSN1 SVO HOflOa MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 9,5: + -a CITY YARMOUTH= MA DATE ',September 13, 202 PERMIT# BLDG-22-001433 JOBSITE ADDRESS 431 ROUTE 6A OWNER'S NAME OOHEARN THOMAS R CT OWNER ADDRESS HOLLAND-OHEARN MARYBETH 431 ROUTE 6A YARMOUTH PORT MA 02675-1824 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO 0 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 1 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 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 :he 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-GASFITTER NAME Albert Cassano ' LICENSE# 9015 SIGNATURE MP 0 MGF 0 JP ❑ JGF ❑ LPG' ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: Cape Cod Mechanical Systems, Inc. ADDRESS. 8 Fruean Way, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX ] CELL 5087769536 EMAIL S31ON M31A3H NVId #11W213d $:33d 111Al213d 3H1 SV S3AHJ3S NOI1VOIlddV SI1-11 oN saA S31ON NO1103dSNI 1VNH A1N0 3Sf1 HO103dSNT210d 30Vd SIHI S3IONNO1103dSNI SVO HOfOH