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HomeMy WebLinkAboutBLDP&G-22-004035 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/21/22 PERMIT# BLDP-22-004035 JOBSITE ADDRESS 53 CROWES PURCHASE OWNER'S NAME RIVERIN MATHIEU P OWNER ADDRESS LAFONTAINE LOUISE 61 CANNON GATE III NASHUA,NH 03063 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS FLOORS RSM 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❑ 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 Thomas Coughlan LICENSE 8529 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# f 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 ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES ei9i2e6e. • . J7114P 4 _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . VED 1 __ . =' ,:4... �.L1.� ���, s _ A � _____-- MA DATE i I `i -- PERMIT# A`�' 4: •' C_,KLO u e5 tgd.t , „OWNER'S NAME „ 1 '�f/ iI � JA O 2021�BS E DDRESS i. ._. ` o DRESS _ 1 TEL__--__�_.�s�-.___--_--__JFAX L__1 BJILDItJ�utNAR iR - - CY TYPE COMMERCIAL ® EDUCATIONAL L I RESIDENTIA PRINT CLEARLY NEW: El RENOVATION: D REPLACEMENT: PLANS SUBMITTED: YES © NO N FIXTURES 1 FLOOR-► BSM 1 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1..- L . L. . J . _ I 1 ._i CROSS CONNECTION DEVICE =�.:'� : I _�_ .3y; - Lx- •� �i ^ „` DEDICATED SPECIAL WASTE SYSTEM 1__ ' I ___ _ J 1- DEDICATED GAS/OIL/SAND SYSTEM �1 _ _ DEDICATED GREASE SYSTEM Jr ... ' --- DEDICATED GRAY WATER SYSTEM Mil . _ r7L_L K - — - � _ . -J _.-, DEDICATED WATER RECYCLE SYSTEM �: I - � -1 � ._t —1� 1����� DISHWASHER 1 .- - -- 1 _t .._.____' - . - a .,�_ _ .__ __� 1I ;1- - . '= w -- DRINKING FOUNTAIN -� -� FOOD DISPOSER 1 . 1,,_ i. '' _a _ ,,1 _.`~L -,. „I ._.. _ HI.. _II. . . .... - FLOOR /AREA DRAIN - - t - INTERCEPTOR (INTERIOR) _11_,1 I _ �^ i. ► • . _ _:1__ li j' ` KITCHEN SINK : _ I. i . I :s -- ' - ?!�.Y.,t_. .,�4,...�,1 _i ..� .- 1 . --1i — LAVATORY 1:7_71I - 11 II - r--- -- 1L._.._ f. I L II .- - ' . . - - ,___,1 ROOF DRAIN .. ._... .�. _ � ...�.,t_. R TALL 31_. __a.1 .�,; I�,r..w'i .. I_-.,.-M r I ___ 1 _ SHOWS S -�L. -�,-.- � SERVICE / MOP SINK L i _ ` �' 11 I1 1•-_.,,. L._ "'..C _ TOILET _...,� °'' I i URINAL ,' 1 -- . 1 ' I issirdii __._-_i j I i..�_,�L� = L_,.,...i -^ter � I I.._ �i ..--� WASHING MACHINE CONNECTION - = 1 - ,��- _jl -�- - -�-__• ' '�1-I WATER HEATER ALL TYPES - - ! - • li, ___ -.a: �ilia -iiimi• ill ^ " 1L_._.,_.. L�..,�. ' . . AWATER PIPING 11_ IL___,,1 ,...._,•4L_ I -I .,.,JL__ L____.. 1 _z.' - 1I_1......��A., _�' OTHER . - - - -- -4. - - _ -' _. I - - =11111177II _ 1 _ .-.. � __,I _- J I INSURANCE COVERAGE: I have a current Iiabili r insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES' NO J , IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY -I 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. CHECK ONE ONLY: OWNER Li AGENT LI 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 �fiance with all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1,0 f?4,?,->---- Cis ., PLUMBER'S NAME [ '--ilic A^, 5> &fir?,.- LICENSE # .5: + 4SIGNA RE • l - 'PARTNERSHIP•, # f LLC LJ#` MP� JP� /�i".�!--i CORPORATION ��� # , COMPANY NAME A , r1tN -L .e-Cc.c�C✓,':�l - I ADDRESS .� t (}i�� a�! P' v 'YC CITY �,T. ,f!G J STATE . AA- • ZIP - C ,,)-C 1, _..� TEL c r) i FAX �r . EMAIL •_ ; !i, ,^, ` a «. , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK : CITY YARMOUTH MA DATE January 21,2022 PERMIT# BLDP-22-004035 ' JOBSITE ADDRESS 53 CROWES PURCHASE OWNERS NAME RIVERIN MATHIEU G OWNER ADDRESS LAFONTAINE LOUISE 61 CANNON GATE III NASHUA NH 03063 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS—a 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 liabilily 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 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 Stale Plumbing Cade and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Thomas Coughlan LICENSE# 8529 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR. CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL S310N M31/132i NVld #.IIN2j3d $ :33d ❑ ❑ 1IV HRd 3Hl SV S3A?:13S NOLLVOIlddV Still ON SeA S31ON NO1103dSNI 1VNId AlNO 3Sf12i0103dSNI dOd 3OVd SIHI S3ION NO1103dSNI SVO HOf1021 g; ,. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — J[ _et f-- -". ..-•.-C-•} C "cr. . ` O W. MA DATE i /� 5.). -I PERMIT# 2 2Q SIT A DRESS , -' C(&OW�e,S ' u ckgt I OWNER'S NAME 1�' � KtV otj e u I L u� �� ��it P� � RESS , .. _ a I TEL= IFAX 1 By APE OR OCC TYPE COMMERCIAL; EDUCATIONAL I RESIDENTIALT PRINT CLEARLY NEW: ,____i RENOVATION: .0 REPLACEMENT:' PLANS SUBMITTED: YES li NO.-: APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .,.., ._..,. . i, _______1 ___I ____1 I 1 I ___I ___.._I ____I _,___J _._.___I_.______I __I BOOSTER - � =J I � I I r ._ _____I __ ___I �� -� _� I. —_I CONVERSION BURNER i _ I 1 f._ __I; I • __ l ___ ____ICOOK STOVE I I _ ,_. I. I —� __I __1:__I -• ;..I _ __ -__I DIRECT VENT HEATER i -_I -__I __-I°_____f _ ^1 _- _�_j -� I , -_ _- DRYER � _� —I, —I. € l I 1 � 1 I FIREPLACE _ _I ._ I _____I I I 1 I _ .-I . 1 -_._I I FRYOLATOR . 0 FURNACE ______ ! I I I _ I I • 1 I __-__-I -- ; - ___J 1 I 1 GENERATOR i I i _ I I - ► _._.� ! ______I + i � - I ; GRILLE ____a _____I:_..__1 —_[ i_._„�` J ____.1 _ I I __..J _._.____I 1 _._....._1 • INFRARED HEATER J _—I r_1 I I _ `I I ___1 ____I LABORATORY COCKS _•I _ -_} # _ .__.._._1 - I ! I ._...._-I _......__1 ____.__i .___.__I ____1 ______I itMAKEUP AIR UNIT ______ kOVEN __I _._...._.j _,_____._ _ l ___ E ____ I ___ _.I - ...I _____I _- -_! .___.._.._i ' _____J ______I .._�I POOL HEATER I __.I __.____! _______I _I. _____I ._.Y.__.__I _ _I _.._.._...1 .__...._.I ______ ___._..J _ .J ROOM /SPACE HEATER i i ROOF TOP UNIT ._..._...' _ I1 ' _.__.. _._. _ I .__..._! i I --�' r TEST -- H UNHEATER I � UNVENTED ROOM HEATER _r__,_ _._...._..J __-,�; . __....° L ____] 1 ; __� i ; _.,.1 _ i ..�_1 WATER HEATER _I L ' I I } ! , ' 1 - i t _OTHER,_HEATER _ -_._ -— ---- -- _ -— .__I 3 —' � _s _ ► ......_.__..?._._.�.,i _.�I _.._....-' .�I � _.. 1 � 1 � - _ :. ' • .=._o...._ I ...I - Imo_ 1 - i I _._.__ _ i _ I I 1 ! I I I L -- -- • - - - - 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 'NO j I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 'Li BOND U 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 I AGENT ___1 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 provisi n the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. W6)11°-- GPV- PLUMBER-GASFITTER NAME `` /4'4 S Cocter� t L-k LICENSE# .. . [}-AA. SIGNATUR MP Xr MGF :J JP JGF A LPGI j. CORPORATION c#' 7 '7 f PARTNERSHIP L# - f LLC : .. #: COMPANY NAME:;.. Ati"C. /10M0 - x� �, _ ADDRESS - . �'� ) 5,( ,�S' ._..__: i il. �- -- CITY __. . (1-. GCS , STAT ZIP : g---;-1_._._. TEL . .. ' "-�'� '� __.. ..._ __-__ FAX 1 CELL: --..._.. .__... 1 EMAIL 4j1 c _. .. /4"1.L :_ - . . - 3-6 8'9 i)-8 3/I j - 1 4 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 112 A �,. _ 4- c CS,Sy, • `