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HomeMy WebLinkAboutBLDP&G-22-006477 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/10/22 PERMIT# BLDP-22-006477 w JOBSITE ADDRESS 3 JERUSHA LN OWNER'S NAME RUSSO JOHN M P OWNER ADDRESS 353 WASHINGTON ST WINCHESTER,MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURFS FLOORS-s 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 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 Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME lornejussila LICENSE 3tl971 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 84 Bog Lane CITY WEST HARWICH STATE MA ZIP 02645 TEL FAX CELL 5087768943 EMAIL lomejussila@hotmail.com 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 kit*-7,' — / nr MO Ail MA DATE a O OCR PERMIT# '• � � � (JJrn ZOOSI A DRESS 3 J�I— ek OWNER'S NAME UILDP UEPA IIDRESS 5‘Pv€ TEL FAX TYPE OR 9 .=• Y TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Li, PLANS SUBMITTED: YES❑ NO-54 FIXTURES T 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 ROOF DRAIN SHOWER STALL SERVICE!MOP SINK TOILET ' URINAL . WASHING MACHINE CONNECTION • WATER HEATER ALL TYPES WATER PIPING OTHER T INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES;kl 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 i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L 1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true d accurate t e best of my knowledgf and that all plumbing work and installations performed under the permit issued for this application will be in com • nce th all rune "provision of the Massachusetts State Plumbing Code and Cha er 142 of the General Laws. , fr 7 > 1� PLUMBER'S NAME or/;>° J / �' LICENSE F e7/ SIGNATURE MP❑ JP, r • CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME /8V /U�'t/nc1//e-cft/,4a, ADDRESS �/ �; / - CITY geri/v/1 STATEM/4 ZIP Qo215-7 T FAX CELLS JOB )i ' '. ,- EMAIL O��,2 1.�5/� �'/U7///4'J/' ( r`"' 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 _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 10,2022 PERMIT# BLDP-22-006477 I'-` JOBSITE ADDRESS r3 JERUSHA LN —1 OWNER'S NAME RUSSO JOHN M G OWNER ADDRESS 353 WASHINGTON ST WINCHESTER MA 01890 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES❑ NO 0 FIXTURES FLOORS-s 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 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 lorne jussila LICENSE# 31971 SIGNATURE MP❑MGF❑JP El JGF 0 LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑#_ COMPANY NAME: ADDRESS. 84 Bog Lane, CITY WEST HARWICH STATE MA ZIP 02645 TEL FAX I 1 CELL 5087768943 EMAIL lorneiussila ihotmail.com S3 LON M3IA3b NVlld #1IIN I2d $:33d ❑ ❑ 1I11d3d 3H1 S`d S3A213S NOIIY011ddV SIHl oN s8A S3ION NOI103dSNI 1VNId A1N0 3Sfl OI33dSNI 2iO3 3OVd SIHI S31ON NOI103dSNI SVO Enna' • �� _ •'pt. ACI-OUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK = :a 1 V E ill ,tk r CITY v7,5/ /1(1);67-4711-1 MA DATE �� t+.— 1 0 2 , Inaj N ova PERMIT.� 1LSIT ADDRESS eCU 5i��. OWNER'S NAME PERMIT BuiLG UEP4MRA RE SS 501 1?'I�. TEL FAX iY -- — — 1 MI, Off— OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT ❑ DU.,ATICiPJAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS,SUBMITTED: YES❑ NO5 APPLIANCES-1 FLOORS-4 SE:10 1 2 3 4 5 F 7 U BOILER - 9 10 11 12 1; 14 r BOOSTER —y — ---1CONVERSION BURNER COOK STOVE DIRECT VENT HEATER J DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR -r--=J GRILLE INFRARED HEATER LABORATORY COCKS ________4 MAKEUP AIR UNIT ,__1 OVEN POOL HEATER • - - - L___I ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER . I j OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVIGL.Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X 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. . CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT s -• I hereby certify that all of the details and information I have submitted or entered regarding this application are true a 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 comp• a wi all P i t provision of the �' Massachusetts State Plumbing Code and Chapter 142 of th Li 1 P General Laws. PLUMBER-GASFITTER NAME Aar he �" >/e 3�yh1 LICENSE# SIGNATURE MP ❑ MGF❑ JP 'J-Apfb,y/i/(171;i5 JGF GI El CORPORATION❑# PA. ,TNERSHIP❑# LLC❑# COMPANY I�lAME JL) ADDRESS V /-1)e. CITY /�1Gfirl�ll(•�^ /n� �J STAT,Eq///„/` ZIP 615 T L FAX CELLSC'e J7 _ b/7,3 EMAIL 4(A° /l'f ) c �/ I� ��/�`>l 1 tall;' ROUGH GAS INSPECTION NOTEj, THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPKTION NOTES 'ley No THIS APPLICATION SERVES AS THE PERMIT FEE: v PERMIT ft PLAN REVIEW NOTES