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HomeMy WebLinkAboutBLDP&G-23-003019 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/2/22 PERMIT# BLDP-23-003019 JOBSITE ADDRESS 35 GINGERBREAD LN OWNER'S NAME Susan Hill .ems P OWNER ADDRESS 35 GINGERBREAD LN YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 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❑ NO❑ 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 Andrew Leighton LICENSE 16130 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@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 6-4 S ( .) /--/e etc cam/ ,--7,'a ,e mC - ./0‘ ` /CofioL d j-sa".s/r/0/n1 7 70R, ' „,. '-i ` a MASSACHUSET a S UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WOIR.I l CITY •T_ Yat( 010 c5: („ _ MA DATE c i f .9c 0 .. . PERMIT* -• JOBS1TE ADDRESS Sv',/N, evioce.j Lc\ : OWN 'S NAME; vs ci,6 ' // � OWNER ADDRESS . TYPE � � rF , ---� EDUCATIONAL � - REsica-�A=.�' TYPE OR OCCUPANCY COMM RCIA�T PRINT l - REPLACEMENT: - PLANS SUBNt , - YES CLEARLY 't NEW: �„z RENOVATION: E REPL CEMEl : FI.X URES Z FLOOR— 3SM 1 1 , ., 1 2 ---- CROSS CONNECTION DEVICE - --. : i DEDICATED SPECIAL WASTE SYSTEM •- _ -- _ - . DEDICATED GAS/OIL/SAND SYSTEM _I.. Milt _ I DEDICATED E' GREASE SYS"'E`� - � DEDICATE)D GRAY WATER SYS i r . ; --"5 - - - _ SYSTEM EM _. t DEDICATED WATER RECYCLE __.. ._ �- _ _. _ _ _ - __ - DISHWASHER �. _- .._ �■■� � :� `. . DRINKING FOUNTAIN • M _ - FOOD DISPOSER -- 7. FLOOR/AREA DRAIN I? .__. _ � - :� �`: _ E IN T ERGEPT4R(INTERIOR) __-- - _ _ KITCHEN SINK _-_ _ _ _ 1M 'T -- LAVATORY -_ . .. _ — _ . : . _.._.._ �� . ROOF DRAIN � - .' _ SHOWER STALL 17- - -- _ _ _: ` _ SERVICE 1 MOP SINK 1 -TOILET - __. 'W = RENAL � . -� :� �' mpopiwTaimilmolit_ � :. U - - �rAsxlNG MACHINE CONNECTION I _ - _�� : WATER EATER ALL TYPES W -` WATER PIPING - : _-• _ OTHER -*!!i _ . - . .. 1.111; !ice INSURANCE COVERAGE: I have a current I'�apolicyor its substantial equivalent which meets the requirements of MGL Ch. 142. YES ; NO L. � .a�� ' IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABiLi "INSURANCE POLICY : _ . OTHER 7 ,`FE OF INDEMNITY BOND ; _ ' ' licensee does nothave thed 142ter of th OWNER'S INSURANCE WAIVER: am Fitton waro es this Massachusetts General Laws,and my signature on this permit application CHECK ONE ONLY: 0 ER = A.G SIGNATURE. OF OWNER OR AGENT e to z ;r 1 hereby all ply that all aE#ire des tulsinst and irk rrave submitted or entered Ong�s apt Pew in and that all piumbfng work an it ons performed under The permit issued for this application ma I/ in oorn with Massachusetts State PIurtCii r9 Code and Chapter 1.42 of the General Laws- NNDREW LEIC-'rITQN LICENSE . PLUMBER'S NAME - i r F LiC # ti. .-- CORPO A-TIC ^ ' 4C _PARTNERSHIP_-._. * _ --� _ -..,= JP; . COMPANY NAB' HALL OIL COMPANY INC. _ i ADDRESS RT 134 435 -- �? Z'tP 0286 I TEL 1 CITY! SOUTH DENNIS _ STATE E UJA ZQX I cnR.?gAtu.3088 i CE_L s EMAIL ha aico Cp2nyagrnal-{ 7-- - ------ ____ _______ .__._ • • • • x ;{ �• �«•,- i' *S- "y..`i, '�'•;_ .+ t:;?gFe.' .:. ., -*... -r'f 4�+3' »t'- .t tit a - iep 1r -.s7r t _ • • • • Ewa , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _. CITY YARMOUTH MA DATE December 02,202;PERMIT# BLDP-23-003019 JOBSITE ADDRESS 35 GINGERBREAD LN OWNER'S NAME Susan Hill G OWNER ADDRESS 35 GINGERBREAD LN YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:at PLANS SUBMITTED:YES❑ 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 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX 7 CELL EMAIL halloilcompanvlUU.9mail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ID FEE: $ PERMIT# PLAN REVIEW NOTES .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TOP PE RFORM FORM GAS FITTING WORK II r�_s ,tom a/ ui_ CITY1--"A§ 110 _ �,� �.x /l �� PERMIT # 23 7= ..7 MA DATE JOBSITE ADDRESS 3.s G- ___:..r.. _% Q(. G�aeQ-._L.rl_____... OWNER'S NAME i . - -- ---.. .. ,._ � �jSa./) /--i% / G OWNER ADDRESS '` ' ' n - - '�:.�__. TEg6b - - FAX 5�� TYPE OR _ _ �. .�_.. ir , � _..: � :.: PRINT OCCUPANCY TYPE COMMERCfAL EDUCATIONAL RESIDENTIAL{„ CLEARLY NEW:J RENOVATION:Li REPLACEMENT: IK.-- PLANS SUBMITTED: YES APPLIANCES � N 0 1 FLOORS-' j 8SM 1 2 3 4 I 5 ' 6 7 I 8 9 10 11 12 I 13 14 BOILER f • ` . BOOSTER . _# ;. .-t=• ,.�,._.j ._ __ ��, (; lin- CONVERSION BURNER ~ 1. � x{ ~.l. _ 'I_ , • • i I-2,-r-j_n..:n r�t ,-31. _ 7 COOK STOVEr-- .- _ f . • __.�� ,�.y,_ ._ ';.� - _ __ _� - �.t _ 1 it S. 11 _ F! - fir• �7.J DIRECT VENT HEATER ,_. ., _ 1 J i�_ , _-' . ....._' �_ ._ . DRYERM.�` ! 3 (� j�, _ , FIREPLACE r FRYOLATOR - --W= -�-_;:-- �-. i � °= x � -- FURNACE _._ 1._ ,,j _._ +1 F T�,-.,J I�r GENERATOR .ii__ :-- - i� ii-. — - _1. GRILLE F _ 4 ..,;KY�:._I I nili €E =;_; . J :r i ]. INFRARED HEATER - -- � 3 �' .�_ _ t LABORATORY COCKS , "..; `; �,.. f� ,.:.;-�. f..,�_-��. MAKEUP AIRUNIT � ---- F. :: €r -v i` OVEN __ ,_ # ' _ r.. ... l POOLif : c f HEATER i i fv --�t = +� . , .• ROOM 1 SPACE HEATER I' �; ROOF TOP UNfT Jr__ } I ( ,�' TEST UNIT HEATER ag‘.,_____ �M M�Ew i M � r ._.__UNVENTED ROOM HEATER s: l i i :=�..� Y�IATER HEATER r i ' - . s OTHER _ _ • i i i - r- - - ; ININ L _.. III INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YE Or4 NO tiOK 3 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 LIABILITY INSURANCE POLICY ` OTHER TYPE INDEMNITY EJ BOND El I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Genera l Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER L# AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this appiicati are friend cura • o the '=st of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will a in complane with - Pertin: t provision p vi on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. --..., i PLUMBER-GASFITTER NAME A ez r zL fz:f;,e:t T j LICENSE # ,/.rvt -_,. SIGNATURE MP �' MGF 0 JP L i JGF `. _1 LPGI 1_. 1 CORPORATION �# [3)JL/ J PARTNERSHIP[i i# LLC # -- COMPANY NAME• = �_.�_ __ •_. � �C ape.- ADDRESS1.1 ,>.__3_,,?,_ _ . _... .. *_ ....,_ , ,. . . . ___ . -.f CITY S'o, 1 v, : 5 STATE i ZIP 6"4•1� 1TEL - 3 Z F AX Lo ...1. ., � CELL r.., > _,__.. J EMAIL .���...�4 co,, u ' e_-;a _J//� �- €-/ __ j ( �! � i.c,..« _- -..... , -- .--'emu_ �� 1 v €ate=` .»<. ;,._ a ;