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HomeMy WebLinkAboutBLDP-23-001048 - r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s, CITY YARMOUTH MA DATE August 26,2022 PERMIT# BLDP-23-001048 JOBSITE ADDRESS 38 SPRINGER LN OWNER'S NAME SCALI RICHARD V G OWNER ADDRESS DUNLAP CHRISTOPHER L 38 SPRINGER LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 Gregory Selfe LICENSE# 26714 SIGNATURE MP❑ MGF ❑ JP© JGF 0 LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: GREGORY A SELFE ADDRESS. 41 SPRINGER LN,41 SPRINGER LN CITY WEST YARMOUTH STATE MA ZIP 026734930 TEL FAX CELL EMAIL selfegreq vahoo.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 .86 0 l 5 NIASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK alt IVED ' t 6 ---Crr Yh(ZM°c MA DATE 4"a6-a�- PERMIT# Z3— AUG 2 6 2O2s► E DRESS 3 g SPe.'M6- mac OWNERS NAME S'A-It SL UILD G DE PPF{TNI DRESS 5- 5e4%(16C_ Lf y' TELi 7e)-n (-44415 FAX . CY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[] PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES FLOORS—+ BSM 1 2 3 l 5 6 7 0 9 10 11 12 13 I 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR L GRILLE r INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST __ UNIT HEATER UNVENTED ROOM HEATER L WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES s' NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1, 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 P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE 6),t IGN LIRE MP ❑ MGF❑ JP E JGF❑ LPGI ❑ CORPORATION❑tF PARTNERSHIP❑ LLC 0#i: DB it COMPANY NAME G 6ogy C-CICc P(C-M&n6 Cele,/rcc ADDRESS `f( seelnbre-Cat CITY w yframv STATE PI$- ZIP cad 61 3 TEt.CS ) f'�1?-1(13Y FAX CEI e) -r Y 3 f EMAIL 5"C I f C.4("1-C yto-iLcb I I I I 1G� PA G I I 0 1 I I I 4 I I 1 1 ll i I zo 2 , c 0 I >- 1 v.1 G I U ul I I- F w �, re w I Z.. It eu I e_ w _ O Lia> GA _UJ co 0 k EL 11. GrJ iii — v I I LL I C� I y Cy G o 1 �1 or 4 V d i i i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK c. CITY YARMOUTH MA DATE 8/26/22 PERMIT# BLDP-23-001048 JOBSITE ADDRESS 38 SPRINGER LN OWNER'S NAME SCALI RICHARD V P OWNER ADDRESS DUNLAP CHRISTOPHER L 38 SPRINGER LN WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:m PLANS SUBMITTED: YES NO❑ FIXTURFS • FLOORS-0 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 Gregory Selfe LICENSE 26714 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP El# LLC ❑# COMPANY NAME GREGORY A SELFE ADDRESS 41 SPRINGER LN 41 SPRINGER LN CITY WEST YARMOUTH STATE MA ZIP 026734930 TEL FAX CELL EMAIL selfegreg@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMIT# PLAN REVIEW NOTES ti r .. . a,:,--7.--1 f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK id - IVED j c �4 /hR e MA DATE g' a 6• PERMIT* Z- -- /6 /O 2 h nY S ' I DRESS 3 S S P(.i N 6 E-L s-nc OWNER'S NAME I rch(-f�• SCA.it re_ jD I L D D E PA ��RESS 3 8 see) 1Y 6 F lc 1-�-tic_ TELQ,91111-y a-1S FAX v JJ�� TYPE OR OC 1 1' Y TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL till' PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:fit] PLANS SUBMITTED: YES 0 NO 0 i-FIXTURES 1 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 1 AREA DRAIN INTERCEPTOR(INTERIOR) ' _ KITCHEN SINK _ LAVATORY ,ROOF DRAIN SHOWER STALL Y SERVICE!MOP SINK _ _ TOILET URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / _ WATER PIPING - _ = _ = ` OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES tit NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POUCY egl OTHER TYPE 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 1 Massachusetts General Laws,and that my signature on this permit apQfication waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT LU 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. '�'`''\ `c PLUMBER'S NAME&EktySe.1 Pc. LICENSE#a6,"( . U SIGNATURE MP 0 JP] CORPORATION 0# PARTNERSHIP❑.# LLC 0# 3)&1+ COMPANY NAME 6itE key 5e-I-Fe P'dr7A,eq. ADDRESS &( I SP R I no(e_ L/-n c CITY (^)' P R''n s' • STATE V1'I s4 ZIP O a-6 7 3 TEL (sot') • - '—r ca 4 FAX CELL Cod') »C_, Y3-r EMAIL S.c 1 P.r' e )/A-h oo. ea.., ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPE ION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT Q � FEE: $ PERMIT# PLAN REVIEW NOTES •