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HomeMy WebLinkAboutBLDP&G-22-005792 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ti.t7r1 CITY YARMOUTH ] MA DATE 4/11/22 PERMIT# BLDP-22-005792 AWN JOBSITE ADDRESS 7 HARDING LN OWNER'S NAME LACROSSE MATTHEW N P OWNER ADDRESS 7 HARDING LN WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 D NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE 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'S NAME Francois Paravisini LICENSE 16211 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME FRANCOIS PARAVISINI ADDRESS PO Box 2585 CITY Orleans STATE MA ZIP 026536585 TEL FAX CELL EMAIL bayside@thecapecodplumbers.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES 5 PERMIT H PLAN REVIEW NOTES •+ MA88ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK \s r CITY/TOWN Y A R M ct&T N MA DATE Li(LI 12 Z PERMIT# Z 2 - S `i z- JOBSITE ADDRESS - 1 IA IA R 6 t fv ( 4 v icy OWNER'S NAME LA C N u�S L p OWNER ADDRESS TEL 17y'7 2 Z"399 2 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ad INT - CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT: V- PLANS SUBMITTED: YES 0 NO 0 FIXTURES Z FLOOR-. ESM 1 2 3 4 5 5 7 5 9 10 11 12 13 14 BATHTUB , CROSS CONNECTION DEVICE , I, , 1 DEDICATED SPECIAL WASTE SYSTEM p , DEDICATED GA810UJ8AND SYSTEM DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM + , DEDICATED WATER RECYCLE SYSTEM ' L , DISHWASHES i , DRINKING FOUNTAIN k _ FOOD DISPOI3ER s , MOOR/AREA DIM , -INTtPTOR(INTERIOR) KITCHEN SINK , LAVATORY _ k I ROOF DRAIN SHOWER STALL - r. _ SERVICE 1 MOP SINK TOILET _ . t IVAL , WASHING MACHINE CONNECTION , WATER HEATER ALLTYPES I WATER PIPING OTHER _ INSURAI(E COVERAGE: I have a current lability Insurance poky 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 UABIUTY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OMiRER'S INSURANCE WAIVER:I am aware that the Howes Sots not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application&au this requirement, CHECK ONE ONLY: OWNER ❑ AGENT 0 g1pNA��►JRE OF 4! I� O�R SENT I hereby certify that al 'des dehie d i n Jove aubmkted or entered regarding this application are true endt�euraa to the ge and that all ptunbl S work and IndilliSons ad under the permit issued for this application will be in_3mglience with a revision of the Msess iuestts State Plumbing Code and Otupter 142 of the General Laws. —.(:•,, • PLUMBER'S NAME LICENSE# 15211 SIGNATURE MP 0 JP❑ CORPORATION rio# 205672589 PARTNERSHIP 0# LLC 0# COMPANY NAME Reyside Plumbing & Heating ADDRESS P.0. Box 2585 CITY Orleans STATE. MA ZIP 02653 TEL 508-255-4555 FAO( 774-316-4249 CELL 774-216.94EI4 EMAIL Bayside@TheCapeCodPlumbers.COm sgz.)- ;)f L _ lq(.,c:. ;..-,D •..;r.r''!-.-.7r• .,117-. 7.7:-.-0,--,-....:%.-;",.-..77..T11".01g1 A ifai iloic-;o5.T.4-4.51.1,1.1c47. .q,lf101w.AU F..-rilatifrOts'..,:':zi,.. ,. , ..gtAer , '.116 ..,..„,,„,...„. ' !k " . . - ,• '.3,,-,.V:i. 'i'. i • . . . .• 3yritaftri ,T An Ay ,.0.4:.!. ,,Prz.) I .. - - '•-.4 .L.y. ••;•••• 1 . , i i 7 -/ -- IMAW 3113VIVI!': ' ' esvci0A7rtvot,... t , I yi.wi frri• ',1.1eriOCIA fil0P50. q ) Iilif41ft:i(813:1 :3 INIORAMICS rl fP•'...-, ...,7m4o.f) BcserymAcit_som Cl ovi nrNTIke Itirratiousw •-•# . il tleimmtnwlp 0:i.tvyil i Y„)f-1.A..;:-..,.10 ! .:,-......., st ti' i •1. I .— p- ----.7:.--. -- -7— — ,----0-. 7 T — r--------: „L '. _ . _ 3 . 11111110 NM . 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If".• •-411•''''-ff :-.,J, rnmerte,, . ..,:..riki7,43,,. ..)keitlfi , .-., it,--,...erc.,..4,17 ,.,„_., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` CITY YARMOUTH MA DATE April 11, 2022 PERMIT# BLDP-22-005792 ` mod' `� JOBSITE ADDRESS 7 HARDING LN OWNER'S NAME LACROSSE MATTHEW N G OWNER ADDRESS 7 HARDING LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: El 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 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 CHECK NG 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 3eneral Laws. PLUMBER-GASFITTER NAME Francois Paravisini LICENSE # 15211 SIGNATURE MP © MGF ❑ JP ❑ JGF ❑ LPG! ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: FRANCOIS PARAVISINI ADDRESS. PO Box 2585, CITY Orleans STATE MA ZIP 026536585 TEL FAX 7 CELL EMAIL bayside ,thecapecodplumbers.com S31ON M3IA3a NVId #11W213d $.33d El ❑ 111U3d 3H1 SV S3Au3S NOI1VOIlddV SIHI oN saA S310N N01103dSNI IVNId AINO 3Sfl a0103dSNI?10d 3OVd SIH1 S31ON NO1103dSNI SVD HOflOa APPNCA Rum Min A FM UM I 1 v rzn,rvnsiu w.,.• ►• ...... ..-•^- Z.Z - 'r 7 12 A- :2:: C1rY yA(L,�1 Q u i I-I MA DATE `II LI� a PERMIT# ' JOBSITE ADDRESS --? N C'to i' I L, vki A I OWNER'S NAME L AC ()SS t G OWNER ADDRESS ' TI3.i71-I -1Z1-2)9RZ.FAX ORTYPE PRIN OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL 0 CLEARLY' NEW:❑ RENOVATION:0 REPLACEMENT:p PLANS SUBMITTED: YES 0 NO 0 APPLIANCES 1 FLOORS-0 1 SPA (f r 1 t 2 1 3 1 4 ' 5 ,_ S T 9 9 14 11 12 13 1 14 BOILER BOOSTER CONVERSION BURNER COOK grovg DIRECT VENT HEATER DRYER • FIREPLACE _ - FRYOIATOR - FURNACE • " �. TOR r rv. c - r � INFRARED HEATER LABORATORY COCKS MAKBJP AIR UNIT ' , OVEN POOL HEATER _ - • ROOM I SPACE HEATER _ foOF TOPUP(IT _ ? h TEST 1 • are HEATER ROOM HEATER :A4VEMATER I 1R - 4 r . . i* ' 1 I i I have a currant hmuranoe policy or Ito eubsta l��e of MOIL Cb.142 YES ® NO 0 lli�l�lL 11F YOU CRICKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UAI II.ITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ BOND OMENS INSURANCE WAIVER:I en mate Smiths Bosses sigaUla the insurance coverage reguirad by Chapter 142 al Ua limsaaohusetb tisnand Laws,and that rny Apia an thle psm aliphatic aideg Etas requirement. CHECK ONE OILY: OWNER ❑ AGENT ❑ thereby airy that ad aft dMele2:15 fnee sUbegtied or Mid Ito - true and %the Wadley Ioee 4e and that ad!gum*.work end wares:unit Issued for Ns with all Parorrnt rg d�-- Mseaeotasul s Sale Plumbing Coda and tt 42 otSr C;s.ws tsora. _ PLUMBER-GABFI TER NAME LICENSE#15211 a SIGNATURE . MP 0 MY El JP 0 JGF 0 LPGI 0 CORPORATION E Q05872589 PARTNERSHIP 0# LLC 0# COMPANY NAME Bari&Plumbing&Heating ADDRESS PPQ. Box 2585 aTY orleane STATE_MA _' ZIP 02853 TEL 508-255-4555 FAX 774316-4249 CELL 774.218-9484 EMAIL Bayslde©TheCapeCQUPiumbers com . -f....;......•lo mows*it•v w .. 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