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HomeMy WebLinkAboutBLDP&G-23-000011 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7/1/22 PERMIT# BLDP-23-000011 JOBSITE ADDRESS 17 SPINNING BROOK RD OWNERS NAME BOROWSKI ELLEN 0 P OWNER ADDRESS TYBURSKI ALICIA 011 APPLEW00D DR CHICOPEE,MA 01013 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m 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/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❑ 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. PLUMBERS NAME Michael Mcbride LICENSE#3681 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride©gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ ArI•••R FEES S PERMIT N PLAN REVIEW NOTES N � MASSACHUSETTS UNIFORM APPLICATION FOR A P RMIT TO PERFORM PLUMBING WORK 1 % I 1 r L 0 .� MA DATE PERMIT# JUliS D 1'ESS T_ �� �� Ao M OWNER'S NAME I�Q (.�. pm 3 004 aR D• SS Ll 3 TEL T se- 5 Ax -0-1§:D WOURANCY PE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL SZ BYP' ... ------ CLEARLY NEW:El RENOVATION:0 REPLACEMENT:g PLANS SUBMITTED: YES❑ NO FIXTURES 1. FLOOR-+ BSM 1 2 3 4 5 6 7 B' 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 I 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 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESZ. NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY q 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 r Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 r- SIGNATURE OF OWNER OR AGENT L'J" 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 and Ch.der 14 of the General Laws. f ' �' PLUMBER'S NAME ' I I • LICENSE# y �/ �/`''�}` SIGNATURE MP 0 JP95 rO P / C) CORPORATION 0# PARTNERSHIP DI iLLC❑# COMPANY NAME rI pi-14-14 ADDRESS 4 4( /�l CITY #17 ,tel4( r STATE ZIP O L.&D/ TEL)>( /d ?i ?? FAX CELL EMAIL /In o/'`.. i1/I i \ nA .. cC 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 .4",' c, CITY YARMOUTH MA DATE July 01,2022 PERMIT# BLDP 23-000011 la? JOBSITE ADDRESS 17 SPINNING BROOK RD OWNER'S NAME BOROWSKI ELLEN 0 G OWNER ADDRESS TYBURSKI ALICIA 011 APPLEWOOD DR CHICOPEE MA 01013 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 12 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/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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 19 Rustic Drive, CITY 'West Yarmouth I STATE MA ZIP 02673 TEL I FAX CELL EMAIL Istinger.mcbrideaumail.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 PLUMBING WORK ►WWII / / - P* E V ■ :* , M . MA DATE o /22-- PERMIT# 1-1 - Oo I N 3 ZBOE ADD• SS I7 S !,In t�►Q I o c C ,_.-1) OWNER'S NAME��T/�1 Lo U 3k / OWN1ER ADD'' SS J TEL '7� � Ti,�! _:_ �/ 7 FAX tyI iDE OieF610-gNCTY PE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRIM I CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:V PLANS SUBMITTED: YES❑ NOV FIXTURES 1 FLOOR-4 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/OILISAND 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 I MOP SINK _ TOILET URINAL , _ WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES WATER PIPING OTHER - — - 1 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 UABIUTY INSURANCE POUCY 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 application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z. SIGNATURE OF OWNER OR AGENT L'J 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 an 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 theGeneralal Laws. �j �(� PLUMBER'S NAME CSC L, C T t`-C`"?LICENSE# I `& 7 SIGNATURE MP El JP❑ Pro P CORPORATION❑# PARTNERSHIP❑.# tic❑# COMPANY NAME c F t T—; 1 - ADDRESS 32 Fr 4^'Law, (A-J`"e n t.). CITY r Ct 4 4 5 STATE `_T - ZIP 6 r2,-th D / TEL 7)if D lO 2/ 22 FAX CELL EMAIL6 7/04_P4 (1 C� C‘ACCL.40 Afft5.0,„d_i--"-CeMAN ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT it PLAN REVIEW NOTES • •