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HomeMy WebLinkAboutBLDP&G-23-003761 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/10/23 PERMIT# BLDP-23-003761 JOBSITE ADDRESS 43 HARPOON LN OWNER'S NAME MAEDER BRIAN P OWNER ADDRESS MAEDER JESSICA 69 AMHERST RD MERRIMACK,NH 03054 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES 1 FLOORS RSM 1 2 3 _ 4 5 R 7 8 9 10 11 12 13 f 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 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 John Kane LICENSE 22755 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOHN KANE ADDRESS 39 MONOMOY RD CITY S YARMOUTH STATE MA ZIP 026641984 TEL FAX CELL EMAIL jkanee45@yahoo.com T ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =p; Ei ---,Tao_ af�r�,..,v CITY =1_I_� / '4, pC �"� MA DATE i ` I :13 PERMIT# JOBSITE ADDRESS ` - 3 I--umr•eUJ L-n . OWNER'S NAME +3 r t ct n (1\o Ci— POWNER ADDRESS S G mt• TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:2. PLANS SUBMITTED: YES❑ NO[6 FIXTURES 1 FLOOR-+ 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 LAVATORY • RF EIVEp ROOF DRAIN — -- SHOWER STALL SERVICE/MOP SINK JAI 102023 TOILET URINAL _ R,jJtDING DEPARTMENT WASHING MACHINE CONNECTION t3v - � WATER HEATER ALL TYPES WATER PIPING OTHER 1 � j INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 2. NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the it Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LI 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 complianc with II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# L X7 S7:5 ' SIGNATURE MP❑ JP 11 CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME TO(Ai K01"L 11u'l`A-"AC-4.4 n9 ADDRESS 3I () Q.1 0, / Rev CITY (�\(ur;M STATE Ma ZIP (3 4)..(1 TEL FAX CELL 5C 8— (o KC' S 6,$`(7 EMAIL s kc n e y$- wo hoe L d 0.'1 C� 3 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i CITY YARMOUTH MA DATE January 10,2023 PERMIT# BLDP-23-003761 JOBSITE• ADDRESS 43 HARPOON LN OWNERS NAME MAEDER BRIAN G OWNER ADDRESS MAEDER JESSICA 69 AMHERST RD MERRIMACK NH 03054 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 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!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 0 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-GASFITTER NAME John Kane LICENSE:# 22755 SIGNATURE MP❑MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME: JOHN KANE ADDRESS. 39 MONOMOY RD, CITY S YARMOUTH STATE MA ZIP 026641984 TEL FAX CELL EMAIL ikanee45l yahoo.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 IP —"� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ‘' • CITY C1r1'YIU.: � i-in 0 J'� Imo, DATE 4 q( a`3 PERMIT f;. JOBSITE ADDRESS L{ 3 14Grpcx, ri 4-n OWNER'S NAME h n Utdir G OWNER ADDRESS S CAm e TEL SO$'3 5.0 TYPE OR FAX PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT: PLANS SUBMITTED: YES❑ NO APPLIANCES 1 FLOORS- BSM 1 2 3 1 5 6 BOILER 9 10 11 12 1; 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - . FRYOLATOR _ FURNACE �- GENERATOR GRILLE l _______ INFRARED HEATER l LABOPJATORY COCKS MAKEUP AIR UNIT • OVEN _ POOL HEATER --� ROOM!SPACE HEATER - --L- ROC)FTOP UNIT E C F V E D TEST • - -------"- UNIT HEATER UNVENTED ROOM HEATER '�� :U� WATER HEATER I OTHER BUI_DIN DEPARTAnt,ii INSURANCE COVERAGE I have a current lia gli 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 Et 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 fMassachusetts General Laws,and that my signature on this permit application waives this requirement. I. SIGNATURE OF OWNER OR AGENTCHECK ONE ONLY: OWNER 0 AGENT 0 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 II Pertinent provision of the •-' Massachusetts State Plumbing Code and Chapter 142 of the General Laws, Q4 PLUMBER-GASFIT'IER NAME �-- LICENSE# 7-a-7SS IGNATURE MP❑ MGF❑ JP ® JGF 0 LPGI❑ CORPORATION 0# PARTNERSHIP 0# LLC COMPANY NAME Sac Kart Ku„ 4-rac- 4-„1-5 ADDRESS , q c D rn yet . CITY_5- • 6 I'm STATE OVA ZIP C 4.4(z TEL FAX CELL SOY-6-..S- S(� b EMAIL <U✓12 -} - a- - -. ROUGH GAS N NOTE,S THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Ye5 No THIS APPLICATION SERVES AS THE PERMIT P I 1 PEE: PERMIT # FLAT REVIEW NOTES