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HomeMy WebLinkAboutBLDP&G-23-000349 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7/21/22 PERMIT# BLDP-23-000349 JOBSITE ADDRESS 27 EARLY RED BERRY LN OWNER'S NAME INSLEY DANA L P OWNER ADDRESS 4071 GREGORY DR DOYLESTOWN,PA 18902 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:m PLANS SUBMITTED: YES❑ NO❑ FIXTURES • 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 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 William Heath LICENSE 12021 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM 0 HEATH ADDRESS 265 GREAT WESTERN RD 45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat330@gmail.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 .r . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK "'— `1 CITY 4 rwa uy-tq j MA DATE l',(,, 17 .Z.)zz i PERMIT# 7-303 `19 JOBSITE ADDRESS,27 1'44 /1e d IA/ OWNER'S NAME /AN S lei . P OWNER ADDRESS v 7 gd'a�..lit TEL 5 7.3 0 7- 9 7 4 t FAX TYPE OR OCCUPANCY TYPE Dyfed ME CIAL I 1 '�Sd EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES❑ NOD FIXTURES I FLOOR-4 I BSM i 1 -1 2 3 4 1 5 6 7 8 9 1 10 11 1 12 13 14 BATHTUB - { '. CROSS CONNECTION DEVICE !' iiii ME DEDICATED SPECIAL WASTE SYSTEM € DEDICATED GASAOIUSAND SYSTEM DEDICATED GREASE SYSTEM f 9 # " 4 =a a DEDICATED GRAY WATER SYSTEM _ •. ` g A. i S .,, r c DEDICATED WATER RECYCLE SYSTEM r f , • _- �- . .,.._.. , DISHWASHER '- DRINKING FOUNTAIN 4 FOOD DISPOSER FLOOR!AREA DRAM } 111111111=- INTERCEPTOR(INTERIOR) - M m,mg KITCHEN SINK ' iiiiiIMMINEMNI ISOMMONNII NM=NM MiNi: LAVATORY ROOF DRAIN SHOWER STALL 3 �.,�, , SERVICE I MOP SINK - TOILET - IIIIIIIIIIIIOIIIOIIIIIPIIIMIIOIIIIINIIIIIIIIMIIIIBIIIIIIIIIIMII--- :NIS M: URINAL ,®Plitillitai WIMP 1 1111 WASHING MACHINE CONNECTION iII11111111 1 ;Emma 111.111 Eli! WATER HEATER ALL TYPES - :: I11.1111 as mini WATER PIPING I OTHER i 'M : . _ . It al= INSURANCE COVERAGE: I have a current;lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES© NO ❑ F YOU CHECKED YES,PLEASE DMICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY fl OTHER TYPE OF INDEMNITY i BOND D 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 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby codify that all of the details and inlomtatton 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 perdorned 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 1 ;LICENSE# I SIGNATURE MPLD, JP CORPORATION❑#1 ,PARTNERSHIP❑# LLC❑# COMPANY NAME I ADDRESS CITY __.. STATE{ ZIP L I TEL r _ . ____ FAX,... .. .CELL t . j EMAIL 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK le.. CITY YARMOUTH MA DATE July 21,2022 PERMIT# BLDP-23-000349 L, JOBSITE ADDRESS 27 EARLY RED BERRY LN OWNER'S NAME INSLEY DANA L G OWNER ADDRESS 4071 GREGORY DR DOYLESTOWN PA 18902 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Ej 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 I 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 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 William Heath LICENSE# 12021 SIGNATURE MP© MGF Cl JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: WILLIAM 0 HEATH ADDRESS. 265 GREAT WESTERN RD,45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat3300gmail.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 RECEIVED JUL 19 2022 ---MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - • G ni- ARTMENT (PA MA. DATE-) (i 17/231e PERMIT# Z3- a 34 • JOBSITE ADDRESS: 27 f I y 4 g• ""7 w OWNER'S NAME I N S f c GOWNERADDRES 'f07 I . v a�t TEL:�7•30 7 '7 L z-FAX: TYPE V yLc3 w1.6W 7r4 D2- 62- Fa- PRINT OCCUPANCY TYPE COMMERCIAL EDUC9/ATIONAL ❑ RESIDENTIAL CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:eV PLANS SUBMITTED: YES 0 NO❑ APPLIANCESI FLOOR-' Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE D ECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR FURNACE GENERATORGELLE tt " LABORATORY COCK LA�BORATOR COCK - • MAKEUP AIR NN 1 A OVEN POOL HEATER ROOM/SPACE HEATER Ni ROOFTOP UNIT TEST UNIT HEATER _ _ 1,1,1 UNVENTED ROOM HEATER WATER HEATER 1 _ INSURANCE COVERAGE - - I have a current liability insurance policy or its substantial equivalent which meets the requkements of'MGL Cis 142 YES erNO ❑ If you have checked yam,please indicate the type of coverage by checking the appropriate box below. LABILITY INSURANCE POLICY 12iV OTHER TYPE INDEMN IY 0 BOND 0 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❑ AGENT ❑ • SIGNATURE OF OWNER OR AGENT hereby wily 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 planting work and installations performed under the permit Issued for this application will be In oompiat ce with ail Pertltent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGMFTrfER NAME IN 1U-.Orh MiQ7I. 1 LICENSE# /Zu:-/ ' SIGNATURE COMPANY NAME: IS F N- £U1 u t K ADDRESS: S/r S2-0141 r CITY:Sr W'a. STATE: ✓I'A' ZIP: 0 1-.I-1 3 FAX TB.:SJS 77b I CELL:771 (iv 9/70 EMAIL 54/5 &AT- 330 (07• ,/. Co MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# c , AD e-ss: