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Home My WebLink AboutBLDP&G-23-005447 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e. CITY YARMOUTH MA DATE 3/31/23 PERMIT# BLDP-23-005447 JOBSITE ADDRESS 118 CROWELL RD OWNER'S NAME MITCHELL BUTLER P OWNER ADDRESS DENISE BUTLER SPELLMAN 77 CARLISLE RD WESTFORD 018860000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESD NO❑ FIXTURES a 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 1 i 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 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. PLUMBER'S NAME Donald Raymond LICENSE 26836 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DONALD L RAYMOND ADDRESS PO BOX 522 CITY YARMOUTH PORT STATE MA ZIP 026750522 TEL FAX CELL EMAIL expertenergyhvac@gmail.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 ;_ -1D-L?4� >f i ivlf� 7 73- 6° �>�7 CITY �'� MA DATE � l(�� (-37) rz w. i y JOBSITE ADDRESS P) Q rc \ . 6, OWNER'S NAME V'. Ar Y,.1..) '` P � Y-oI \ OWNER ADDRESS � `� TEL � ( - 1 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[/ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Dr/ PLANS SUBMITTED: YES❑ NO Er FIXTURES 1 FLOOR-0 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 SYSTEM - DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 ' LAVATORY RECEIVE L � ROOF DRAIN _-.. _ ._ -- ___1---_. SHOWER STALL SERVICE!MOP SINK h ` _ 2O I URINAL ' } . 1L1Jl G ubPART RENT WASHING MACHINE CONNECTION ` I WATER HEATER ALL TYPES y WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ONO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [1/ 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 : OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 4 I hereby certify that all of the details and information I have submitted or entered regarding this application are t nd a r to of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co nce Perjlfi t 76visio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# �S- , 1,v SIGNATURE MP❑ JP 12' CORPORATION❑# PARTNERSHIP❑# �J L,LLC, f❑# COMPANY NAME Ceti; ADDRESS�� --V`�, t ' CJtjai �`) CITY C � STATE %) 4 ZIP (ry -��'t� TEL J ktril L, ` ttD FAX CELL EMAIL` V• t )`�1 0 e.�.1 z L., 0 !:-No' .. _ . . ,•„ . •e•4 I A . . . . . . • . . . — . . • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �. c� �P �� CITY YARMOUTH MA DATE March 31, 2023 PERMIT# BLDP-23-005447 JOBSITE ADDRESS 118 CROWELL RD OWNER'S NAME MITCHELL BUTLER G OWNER ADDRESS [ NlSE BUTLER SPELLMAN 77 CARLISLE RD WESTFORD 018860000 TEL _ _ TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: 0 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 i 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 ❑ 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 Donald Raymond LICENSE # 25836 SIGNATURE MP ❑ MGF ❑ JP 0 JGF ❑ LPG' ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: D()NALD L RAYMOND ADDRESS. PO BOX 522, CITY ,YARMOUTH PORT STATE MA ZIP 026750522 TEL FAX 1 CELL EMAIL expertenergyhvac(a,gmail.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 f'= CITY: MA. DATE 1 r PERMIT#1• JOBSITE ADDRESS:p, es sy OWNER'S NAME V C-AA Gr i OWNER ADDRESS: �+-15 fit' TELI � C _�A:V TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ PRINT ^� CLEARLY NEW:El RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES❑ NO lid APPLIANCES-1 FLOOR-. Bsmt 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 j' INFRARED HEATER W LABORATORY COCK F. , F .Vt o MAKEUP AIR UNIT OVEN POOL HEATER , A123 ROOM I SPACE HEATER .1 ROOF TOP UNIT Z TEST 1 )1L UIraG DE_,'ART44ENT Z UNIT HEATER 14.1 UNVENTED ROOM HEATER WATER HEATER , 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY E� OTHER TYPE 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. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this appOcation are tru nd a ra to the best of ray Knowledge and that all plumbing work and installations performed under the permit issued for this application In ce iip/ t provision of the Massachusetts State.Plurr b Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: J f\ \WSX% LICENSE G RE COMPANY NAME:t c�— ADDRESS: ti CITY: STATE: ZIP: FAX: TEL l LL: EMAIL:" 't MASTER❑ JOURNEYMAN LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑ E m 4-ic. ADD zess : c�Y ;��S J �� v A G