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HomeMy WebLinkAboutBLDP&D-23-001938 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ei CITY YARMOUTH MA DATE 10/12/22 PERMIT# BLDP-23-001938 I l JOBSITE ADDRESS 153 CENTER ST OWNER'S NAME NORRIS PIPPA • P OWNER ADDRESS 36 ASH ST APT 402 CAMBRIDGE,MA 02138-4868 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES z FLOORS-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/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❑ 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 Mark Moran LICENSE 20786 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK R MORAN ADDRESS 16 BRAMBLE BUSH DR CITY FORESTDALE STATE MA ZIP 026441017 TEL FAX CELL EMAIL moranpandh©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 0 , -.e. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY `(Q,rmov��ln MA DATE' 10/5/ PERMIT# Z — (93 =y JOBSITEADDRESS ' 153 CeOrec-53cret?k ' OWNER'S NAME ? pea NOf,-, OWNER ADDRESS i 15.3. CRX ke-C' Stceek ... TEL i51-445-9105 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL V PRINT CLEARLY NEW: RENOVATION: REPLACEMENT. PLANS SUBMITTED: YES $ NO1 FIXTURES 1 FLOOR-+ 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ;, CROSS CONNECTION DEVICE 3_ _ DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM ' 3, 23 DEDICATED GRAY WATER SYSTEM r , , s DEDICATED WATER RECYCLE SYSTEM ' DISHWASHER f I j DRINKING FOUNTAIN - 3 FOOD DISPOSER 4'" 1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) , i _ " KITCHEN SINK _ G LAVATORY f i 1 ROOF DRAIN $: I, x SHOWER STALL n A SERVICE/MOP SINK I a ' TOILET URINAL WASHING MACHINE CONNECTION s . il 1 r _ ' WATER HEATER ALL TYPES WATER PIPING 3 { 5 ' 1 , f OTHER J a I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES#i' 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 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 urate to the best of my knowledge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. will be in co lianc Ith all P ment provision of the and that all plumbingwork and installations performed under the permit issued for this application e i n � 9rti �/14 PLUMBER'S NAME MARK MORAN LICENSE# 20786 SIGL�JNAI`URE MP JP • CORPORATION #I PARTNERSHIP # LLC #' COMPANY NAME; MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE CITY;FORESTDALE STATE' MA ZIP ;02644 TEL:508-648-2934 FAX 1 CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM 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 UCITY YARMOUTH MA DATE October 12,2022 PERMIT# BLDP-23-001938 JOBSITE ADDRESS 153 CENTER ST OWNER'S NAME NORRIS PIPPA G OWNER ADDRESS 36 ASH ST APT 402 CAMBRIDGE MA 02138-4868 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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❑ 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 Mark Moran LICENSE# 20786 SIGNATURE MP 0 MGF ❑ JP 0 JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: MARK R MORAN ADDRESS. 16 BRAMBLE BUSH DR, CITY FORESTDALE STATE MA ZIP 026441017 TEL FAX CELL EMAIL moranpandh(a)pmail.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 43 y CITY cur 3— 173$ .,_ MA DATE 10�5�a2� PERMIT# Z JOBSITE ADDRESS 15% CarNier 'Acee OWNER'S NAME 1:3t QP& NO«‘S GOWNER ADDRESS ‘5% Ceases EkcQ * TEL 4361—` %S- IIOS FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL / PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ✓ PLANS SUBMITTED: YES NO � APPLIANCES 1 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I / 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accu " to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliant wit Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME MARK MORAN LICENSE# 20786 SI`GNA RE6 MP MGF JP JGF LPG! CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934 FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.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 1