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HomeMy WebLinkAboutBLDP&G-22-003723 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘s,_:::93 CITY YARMOUTH MA DATE 1/5122 PERMIT# BLDP-22-003723 JOBSITE ADDRESS 33 GUNWALE WAY OWNER'S NAME DESPINOSA THOMAS F TRS P OWNER ADDRESS DESPINOSA JOANN 53 POMPANO RD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO El FIXTURFS 1 FLOORS-r RPM 1 2 3 4 5 R 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 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 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 david major LICENSE 16378 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME lave major mec. ADDRESS po 234 CITY foxboro STATE MA ZIP 02035 TEL FAX CELL 5084003452 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7:`1"—__k rta, CITY YARMOUTH MA DATE January 05,2022 PERMIT# BLDP-22 003723 JOBSITE ADDRESS 33 GUNWALE WAY OWNER'S NAME DESPINOSA THOMAS F TRS G OWNER ADDRESS DESPINOSA JOANN 53 POMPANO RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES El NO 0 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 r ROOM/SPACE HEATER ROOF TOP UNIT TEST _ UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER s 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER OF INDEMNITY El 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 david major LICENSE# 16378 SIGNATURE MP© MGF El JP❑ JGF El LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC El# COMPANY NAME: dave major mec. ADDRESS. po 234, CITY foxboro STATE MA ZIP 02035 TEL FAX CELL 15084003452 EMAIL r . S310N M31A38 Ndld #111NHdd $ 333 0 ❑ 1111183d 3E11 Sd SAS NOLLV3llddV SIHI oN saA S310N N01103dSNl IYNId AlNO 3Sfl IO103dSNI HOd 39dd SIH1 S310N N01103dSNI Sy0 HJfOH