Loading...
HomeMy WebLinkAboutBLDP&G-23-003866 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 'r� aer CITY YARMOUTH MA DATE 1/17/23 PERMIT# BLDP-23-003866 PE� JOBSITE ADDRESS 11 IVY LN OWNER'S NAME HANLON PEGGY S r v _ P OWNER ADDRESS 30 BEACON ST WESTWOOD,MA 02090-1710 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ 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❑ NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Richard Olsen LICENSE 1/5335 SIGNATURE MP ❑ JP ❑ CORPORATION Ott PARTNERSHIP ❑# LLC ❑# COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 Hokum Rock Road CITY Dennis STATE MA ZIP 02638 TEL 5083855290 FAX CELL EMAIL OFFICE@OLSENPLUMBING.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =g-gairw- , 'A - •S e i;* ‘- a CITY LSDO MA DATE 811000/7 . PERMIT # 6 ' -1-I JOBSITE ADDRESS OWNER'S NAME' ' ' OWNER ADDRESS TELL JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL „_„- EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: i _- RENOVATION: l REPLACEMENT: V PLANS SUBMITTED: YES Li NOL. FIXTURES -1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - - - --1- CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM i DEDICATED WATER RECYCLE SYSTEM ___l DISHWASHER Ain DRINKING FOUNTAIN FOOD DISPOSER ---'' FLOOR I AREA DRAIN .. . ._. INTERCEPTOR (INTERIOR) KITCHEN SINK 1:.. ....�__ . w.. _._. .. LAVATORY ..,_ �_ _-. _. ___., -. - ,r__ - -„.w_ a� _ ROOF DRAIN SHOWER STALL i r� SERVICE l MOP SINK TOILET ai _ URINAL _- _......__ ii WASHING MACHINE CONNECTION 11 WATER HEATER ALL TYPES WATER PIPING __.... __.. _ :_ OTHER . I 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. CHECK ONE ONLY: OWNER 1 AGENT I_ 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 "knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' , e wit rPyinent ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J fl PLUMBER'S NAME ; RICHARD OLSEN LICENSE # M10335 SIGNATURE MP JP LJ CORPORATION 7#, 2166 PARTNERSHIPEI#1 ! LLC L—j# COMPA\JY NAME OLSEN PLUMBING & HEATING ADDRESS [357 HOKUM ROCK ROAD CITY I D ENNIS i STATE 1 MA ZIP [92638 TEL 1508-385-5290 iii- EC+ I FAX 15(►8-385-6963 CELL —1 EMAIL E D P J A N 13 2023 BUILDING DEPARTMENT By: _ . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a CITY YARMOUTH MA DATE January 17,2023 PERMIT# BLDP-23-003866 JOBSITE ADDRESS 11 IVY LN OWNERS NAME HANLON PEGGY S G OWNER ADDRESS 30 BEACON ST WESTWOOD MA 02090-1710 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 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❑ 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 Richard Olsen LICENSE# 10335 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: OLSEN PLUMBING&HEATING ADDRESS. 357 Hokum Rock Road, CITY Dennis STATE MA ZIP 02638 TEL 5083855290 FAX CELL EMAIL OFFICE(a,OLSENPLUMBING.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " . ' - litL >-/ CITY ; ( � (A MA DATE( U1L0?J 1PERMIT # L 3 v (- •rr-a, - . JOBSITE ADDRESS' t y q I C\n e OWNER'S NAME per 1c)(1 trICtnior‘ _ , . OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL - EDUCATIONAL . j RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:lt PLANS SUBMITTED: YES j NO❑ APPLIANCES - FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1' BOILER ----,' ----- BOOSTER CONVERSION BURNER -.- il _ 1I 1 _ __�_. COOK STOVE - DIRECT VENT HEATER ________ DRYER ,_mm.. . - ....: �: . .. FIREPLACE - -.-- _w:: _.�,,..�.. �: _ FRYOLATOR _- _ _ � FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT k___..___ . OVEN �. - POOL HEATER ._ _ - _._:._._ _ 1. ROOM / SPACE HEATER _ :. _ ROOF TOF' UNIT � _ _____ TEST — -- _. s. - -_-- UNIT HEATER _.___ UNVENTED ROOM HEATER WATER HEATER ._ __ ___ _ 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I i NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER i AGENT 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 t best ,y lowledge and that all plumbing work and installations performed under tie permit issued for this application will be in compliance.wi all P in n ig of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7 - t PLUMBER-GASFITTER NAME Richard Olsen w LICENSE # M10335 SIGNATURE MP i MGF ' JP JGF LPGI r1 CORPORATION ! # 92166 PARTNERSHIP LLC #i — _ -..._ COMPANY NAME: H Olsen Plumbing & Heating ADDRESS P.O. Box 2026, 357 Hokum Rock Road CITY erns nis iSTATE MA ZIP 02638 TEL 08 385 52,,29 } 1 FAX 508-385_ �._ , 6963 CELL IEMAIL1 c E.: 0_ oi... ..)- _EiQ) ?1, ) in'. iWcf4A.V. JAN 13 2023 BUILDING DEPARTMENT By. a cc . . • • I ESt�s f HAL