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HomeMy WebLinkAboutBLDP&G-23-002852 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r 'y, c CITY YARMOUTH MA DATE 11/22/22 PERMIT# BLDP-23-002852 ' 11 JOBSITE ADDRESS 1 CYGNET RD OWNER'S NAME KESTEN JAYE ANNE • P OWNER ADDRESS 1 CYGNET RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m 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 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 0 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 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 Robert Judson LICENSE f6399 SIGNATURE MP ❑ JP El CORPORATION ❑# i PARTNERSHIP ❑# LLC ❑# COMPANY NAME ROBERT J JUDSON ADDRESS 34 SCHOOL ST CITY MERRIMAC STATE MA ZIP 018601938 TEL FAX CELL EMAIL deannas@callrevise.com 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 PLUMBING WORK - t % , CITY 'Yarmouth MA DATE 11/15/2022 PERMIT # JOBSITE ADDRESS 1 Cygent Road 1 OWNER'S NAMELaye Anne Kesten P OWNER ADDRESSr _ .....,j TEL 508-685-6600 FAX T 7 TYPE OR OCCUPANCY TYPE COMMERCIAL DI EDUCATIONAL DI RESIDENTIAL 0 PRINT CLEARLY NEW: Eg RENOVATION: . REPLACEMENT: ID PLANS SUBMITTED: YES DI NO® FIXTURES Z FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 J 14 BATHTUB CROSS CONNECTION C EVICE 1111111111.1111111111111 DEDICATED SPECIAL V ASTE SYSTEM111111111111111111111111111111111111111111111111111111111111111 _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM . DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM MI DISHWASHER MI DRINKING FOUNTAIN IIIIIIIIIIIIM - — _ _ __ _ FOOD DISPOSER 11111 FLOOR / AREA DRAIN � INTERCEPTOR (INTERIOR) ffiNa.......6...... � 0. � _� 1 KITCHEN SINK iiliI LAVATORY VIIIM110111.1 _ __ OM 0111110111111 ROOF DRAIN MME,MIM _ M SHOWER STALL - � �M. _ _ SERVICE 1 MOP SINK '1MIN TOILET illIllIllMIIIMMIIIIIIMIIIIIIINIII URINAL IIIIIIIMIIIIMIIIIIIIIMIOIIIIIINMIMIIIIIIIOIIIIIIIOIIIIIIIIIIIIOIIIIIMIIIMIIIITIIIIMIIIIII WASHING MACHINE CONNECTIONS - _ WATER HEATER ALL TYPES WATER PIPING M MIIIIIMMIMIll OTHER r111111.1.11111111111111.01111111111,MI ==.11Nri illii11110111111 INSURANCE COVERAGE: I have a current liabilit'Linsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 13 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 SIGNA-URE 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 compli. • e with all Pertinent provi •n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. . ...----- dAder PLUMBER'S NAME (Robert Judson LICENSE # (16399 J • SI . tAT . • MP I JP j CORPORATION El# 4115 PARTNERSHIP #i LLC Ei#L 1 COMPANY NAME Dipietro Heating and Cooling 1 ADDRESS 32 Middlesex Street I CITY Bradford STATE 1 MA , ZIP 01835 ! TEL 978-372-4111 I FAX 978-241-7325 I CELL 978-914-3131 i EMAIL [deannas@callrevise.com 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK u -7 CITY YARMOUTH MA DATE November 22,202.PERMIT# BLDP-23-002852 JOBSITE ADDRESS 1 CYGNET RD OWNERS NAME KESTEN JAYE ANNE G OWNER ADDRESS 1 CYGNET RD WEST YARMOUTH MA 02673 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 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 El 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 Robert Judson LICENSE# 16399 SIGNATURE MP©MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IROBERT J JUDSON I ADDRESS. 134 SCHOOL ST, CITY IMERRIMAC ISTATE MA ZIP 018601938 TEL I FAX CELL EMAIL Ideannasna,callrevise.com • ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r- iNes.:Th:_44_„7i,e' CITY Yarmouth MA DATE 11/15/2022 PERMIT # s<. JOBSITE ADDRESS1i1 Cygent Road OWNER'S NAME Jaye Anne Kesten 11 GOWNER ADDRESS TEL 508-685-6600 FAX l j TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: J RENOVATION: ❑ REPLACEMENT: v PLANS SUBMITTED: YES 0 NO APPLIANCES Z FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I r I 1 I -1I I BOOSTER CONVERSION BURNER I -_ 1 -- - I I I COOK STOVE L - - NM IIIIIII -- DIRECT VENT HEATER Lgi � _ r m DRYER H_H■MI IMMI FIREPLACE ,. FRYOLATOR FURNACE till ® �_ I. li GENERATOR GRILLE J. 1 I 1 _ "Pin INFRARED HEATER LABORATORY COCKS 1 1 MAKEUP AIR UNIT f OVEN POOL HEATER r ROOM / SPACE HEATER _ ROOF TOP UNIT __ _ - _ _ I lir � �TEST UNIT HEATER Ing I: UNVENTED ROOM HEATER Mill Iill!lill _ WATER HEATER a ( I OTHER _ _ .I i 1 1 1 - .t .1 III- 4 f 0 M I 'I 1 0 I 0 I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1 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 wor< and installations performed under the permit issued for this application will be in cornplia ce with all Pertinent pro ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /�, �� A I I I I Or PLUMBER-GASFITTER NAME Robert Judson LICENSE #116399 li / . N • iRE MP v MGF C JP L JGF LPG' CORPORATION mil# a115 I PARTNERSHIP # 1 LLC a E. ---1 COMPANY NAME: DiPietro Heating and Cooling ADDRESS I32 Middlesex Street CITY Bradford STATE MA 1 ZIP :01835 1TEL 978-372-4111 1 FAX 978-241-7325 I CELL 978-914-3131 _ EMAILLdeannas@callrevise.com