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Home My WebLink AboutBLDP&G-22-02835 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, r CITY YARMOUTH MA DATE 11/16/21 PERMIT# BLDP-22-002835 JOBSITE ADDRESS 128 CLEAR BROOK RD OWNER'S NAME Ronal Huyser P OWNER ADDRESS 128 CLEAR BROOK RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENTS,El PLANS SUBMITTED: YES El NO❑ FIXTURES FLOORS-' RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 El 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 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 Ronald Huyser LICENSEI2F1046 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD HUYSER ADDRESS PO BOX 944 CITY MARSTONS MLS STATE MA ZIP 026480944 TEL FAX CELL EMAIL none 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 s� Rl: i_ �— 'j yan()LA_ r //;; MA DATE PERMIT# Z Z ? 3 - fix,.Q 4:171 (/� ta T- ----- . Y fE ADDRESS .ems C 1 ..QDtr l�I l,�,IC, C. OWNER'S NAME l'l UG-). -L`` Ni cgf 0, NOpi 5 2O22WN ADDRESS \ S C(\' _ CL� CS y,.)� �� TEI.-ra a c //c6 FAX B J I L fi I g RA F- + IP uCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 'y --PRIM. CLEARL RENOVATION: ❑ REPLACEMENT:Kil PLANS SUBMITTED: YES❑ NO in FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Y CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OILISAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM r - DEDICATED WATER RECYCLE SYSTEM _ _ DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER _ _ _ FLOOR 1 AREA DRAIN _ _ _ INTERCEPTOR(INTERIOR) _ KITCHEN SINK _ LAVATORY - ROOF DRAIN + i SHOWER STALL T• SERVICE I MOP SINK T l I TOILET _ URINAL _ WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES }C _ _ WATER PIPING _ _ OTHER INSURANCE COVERAGE: l 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'g] OTHER TYPE 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 I. Massachusetts General Laws,and that my signature on this permit application waives this requirement. -1...-::'''' � CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I 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 c pliance with�e� ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - • PLUMBER'S NAMI=�t✓ � �` 3� LICENSE#)\Vy�,. SIGNATU/ MP ❑ J' a CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME (`) C ?1L111,1 bi ill ADDRESS v b C 14L4 _ CITY rS S \:� STATE��(A, ZIP (CA,CL C1 TEL ( C)1 1 i Li 5 FAX CELL ,Od't7 !to)/( EMAIL - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =_ BLDP-22-002835 =_ !_ : CITY YARMOUTH MA DATE November 16, 202' PERMIT# r ,i. JOBSITE ADDRESS 128 CLEAR BROOK RD OWNER'S NAME Ronal Huvser G OWNER ADDRESS 128 CLEAR BROOK RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ 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 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 l 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 INDEMNITY0 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 Ronald Huyser LICENSE # 21046 SIGNATURE MP ❑ MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # 1 COMPANY NAME: RONALD HUYSER _ ADDRESS. LPO BOX 944, J CITY MARSTONS MLS STATE MA ZIP 026480944 TEL 1 FAX CELL EMAIL Inone i S310N M3IA3iA NVld #LI1A113d $:333 ❑ ❑ 111A1213d 3H1 SV S3A8DS NOI1VOIlddV SIHl oN se), S310N NO1103dSNI IVNId AINO 3Sf1230103dSNI 210d 3OVd SIHl S31ON NO1133dSNl SVO H00021 1 l MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK `a y- CITY: yarnia1�-Y/ 1 44e-- MA. DATE PEP 1Tr (L � _ ? RE. ' > ! VICESO,DDRESS:i k C,1 arc2)0v Y.. eJV1NI lEP'S NAI��E P I�... IIG OWN .ADDRESS: S Q,✓U_ a S V TEL: JbY o�9a // 1�� Yrrl' ( R5 20aCU AN-Y TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL _ PR 'T iu EYNA'HIllt I RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES 0 NO❑ I APPLIANCES- FLOOR-{ 1 Bsnt 11 I 2 3 1 4 1 5 o I 7 I 8 I 9 I 10 11 12 13 I 14 I BOILER I I I 1 I I I I I BOOSTER I I I 1 I I I I CONVERSION BURNER I 1 I I I COOK STOVE I I 1 I I I I I I DIRECT VENT HEATER I I ! I I I I I DRYER FIREPLACE I I I I I I I FRYOLATOR I I I I I I I I FURNACE I I I I I I . I I I I GENERATOR I GRILLE INFRARED HEATER I LABORATORY COCK I I I I I I I ! MAKEUP AIR UNIT I I I I I ! I 1OVA! I I I I I I I I POOL HEATER 1 I I 1 I I I I I ROOM/SPACE HEA I t.I: I I I I I I I I I I I ROOF TOP UNIT I I I I 1 I I I_ I TEST I I ! I I I I 1 I I UNIT HEATER, I I I I I UN\'EN—iED ROOM HEALEH I I I I I i I I WAIr_I-tHEAIht I X ! I I I I I I 1 I I I I I ! I I I I II - I I I I I I I I I I I i I 1 I INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL Ch.142 YES.in NO D It you have checked YESs please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 174 OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAVER: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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT l_ 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 A all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLU MBER/GASFI I I R NAME 6\'Y ,d . a LICENSE# �7d0 SIGNATJ � COMPANY KAME:v L `W ` ADDRESS: ea. .T X CITY:1 I lG Y S ,L.I i (S A/(o, STATE MA ZIP: { d lQ`1 FAX: TE��U> C�.S `I q S CELL: vinG e/ e nom -77—t o -- EI _ MASTER 0 JOUPNENANIO LP INSTALLER❑ CORPORATION❑t PARTNERSHIP❑= LW .r • • i I I ► I I 1 I 1 I I ► ?� ! • I =- 1 ! 5 I ! ! z I• I I Z I O I I ► , 1 V , Z � T i - I . - i 1 i I I I I I I zD I I Z Q '3❑ : I 3 I I U u r i , Er) C I C u E Z o I :=K _1 :z-z - Li. J O U I LI-) \L \ . . \\ \ \\ \ I\ I\ u !- \\ \ \\ \\ \ \ \ I\ 1 \ \ 0 i ' \ \ \ \ I . 1 \ \ \ t4 \ 1 0 \ .\ \ \ - I !