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HomeMy WebLinkAboutBLDP&G-22-000409 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1t*-7 ,40 CITY YARMOUTH MA DATE 7/22/21 PERMIT# BLDP-22-000408 JOBSITE ADDRESS 52 CROWES PURCHASE OWNERS NAME RUGG PAUL M P OWNER ADDRESS 52 CROWES PURCHASE WES—YARMOUTH,MA 02673 TEL TYPE OR OCCUF'ANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS • 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 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 El OTHER TYPE 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 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. PLUMBERS NAME Kevn McBride LICENSE#1620 SIGNATURE MP El JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Kevn McBride Plumbing and Heating, ADDRESS 11 Cocheset Path Inc CITY West Yarmouth STATE MA ZIP 026732559 TEL 5087784556 FAX CELL 5083643724 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 1'L 1\ Z� Ci✓ Ves No U THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES 4.-r- , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ® 6 kz, ..,,, CITY YARMOUTH 1 MA DATE July 22, 2021 PERMIT# BLDG-22-000409 JOBSITE ADDRESS 52 CROWES PURCHASE OWNER'S NAME RUGG PAUL M G OWNER ADDRESS 52 CROWES PURCHASE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 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 1 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 HEA--ER 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 CHECKIN THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY DI BOND ❑ OWNER'S INSURANCE 'NAIVER: 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 Kevin McBride LICENSE # 11620 SIGNATURE MP © MGF 0 JP CI JGF ❑ LPG! ❑ CORPORATION ❑ # r PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: !Kevin McBride Plumbing and Heating, Inc, ADDRESS. 11 Cocheset Path, CITY West Yarmouth STATE MA ZIP 026732559 TEL 5087784556 FAX 1 CELL 5083643724 EMAIL S310N M3IA32!NVId #11W213d $:33d ❑ ❑ 1WW2I3d 3H1 SV S3A83S N011V011ddtl SIHJ oN saA S310N N01103dSNI IVNIk KINO 3Sl 80103dSNI 210d 30Vd SIH1 S310N NO1103dSNI SVJ H0l02J