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Home My WebLink AboutBLDP&G-22-003589 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLDP-22-003589 JOBSITE ADDRESS 61 WINTER ST OWNER'S NAME ARDEN STEPHEN P P OWNER ADDRESS ARDEN CHRISTINE E 61 WINTER ST YARMOUTH PORT,MA 02675-1247 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES I FLOORS RSM 1 2 3 4 9 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❑ 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 delays 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 Thomas Coughlan LICENS58529 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THOMAS J COUGHLAN ADDRESS 48 HERITAGE DR CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4.Q-411m—f CITY Y/ e /I;'c.)i,{ �?R,,l MA DATE 102 �-J p�f PERMIT # JOBSITE ADDRESS . ( W '�� . 7-- OWNER'S NAME 5TE1,E ab Ai�PI s POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCAT IRLEX E I �jE �TI�1L � PRINT --- CLEARLY NEW: RENOVATION: REPLACEMENT: Fc PLANS S BMITTED: YES NO '<e. DEC 212021 FIXTURES Z FLOOR-. BSM 1 2 3 4 5 16 7 8 9 0 11 12 13 14 BATHTUB BUILDING-DE ARTS NT CROSS CONNECTION DEVICE • - DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 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. 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 compliance with all P inent pi-pillion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t PLUMBERS NAME 1 �rDMIt CO A t�('3 ' �.� LICENSE # ��,�;� 4/1,. SIGNA 'E MP i JP CORPORATION --# t ;` PARTNERSHIP # LLC • COMPAN NAME ' J�'�U f/ A15 1- C�OLI&G, ADDRESS 5 O /) � CITY �/',tw( STATE r ZIP TEL I FAX "CELL • EMAIL y A'j� q 'Q- - 6 nM' • COAAJ G MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kr,e_ . CITY YARMOUTH MA DATE December 28,202' PERMIT# BLDP-22-003589 JOBSITE ADDRESS 61 WINTER ST OWNER'S NAME ARDEN STEPHEN P G OWNER ADDRESS ARDEN CHRISTINE E 61 WINTER ST YARMOUTH PORT MA 02675-1247 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 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 Thomas Coughlan LICENSE# 8529 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL 7 S31ON M31A3H NVId #IIVJN]d $ 33d 111/0,13d 3H1 SV S3/VES NOIIVOIlddV SIH1 oN so), S310N NO1103dSNI TAU AINO 3Sfl a0103dSNI?JOd 3OVd SIN' S310N N01103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s= CITY: �� ++Af tt MA. DATE: /'Y� /!`/ PERMIT# JOBSITE ADDRESS: ( I GU It)Th-r- 17Z ee I OWNER'S NAME: S!ZV£ ! 'R U El ) Cj OWNER ADDRESS: R E:TE I V E 0 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL El UCATIONAL [] REST ENTIAL' PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT: DEC 2 1 2021 pLPNS SUBMITTED: YES 0 NO APPLIANCES. FLOOR Bsmt 1 2 3 4 BU16DINGDEtAGTN EI'Ut 10 11 12 13 14 BOILER ----- - BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YE NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY,kr 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 El AGENT ❑ 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 Pertine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. yJ�? PLUMBER/GASFITTER NAME:__/2� (tea G-fl £-/-A4ICENSE# .F5.29'/A SIGNATURE Li COMPANY NAME: (f K- 64 11,41& eat ty.✓o' ADDRESS: 30 (17,/R 1 SS >jIZf C t CITY: STATE: it ZIP: OVC FAX: TEL: ja--73 7 i/ CELL: SS8 -17a ' -g(l S EMAIL: 'o/Y1 MY 3 c A pt i t. - Cota•.- MASTER- JOURNEYMAN LP INSTALLER❑ CORPORATIONS 44057 PARTNERSHIP❑# LLC❑