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HomeMy WebLinkAboutBLDP&G-21-001155 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 10 , , CITY YARMOUTH MA DATE 913/2 0 PERMIT# BLDP-21-001155 ' �� JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 1 F OWNERS NAME SEACORD CALEB J P OWNER ADDRESS SEACORD ELIZABETH J 1656 ORR TERR THE VILLAGES,FL 32162 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Ea PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES ..I 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 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 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK gyp ` cc�,' CITY WEST YARMOUTH k MA DATE 8/12/2020 .PERMIT#gLb-P- 1-l�I e = JOBSITE ADDRESS 300 BUCK ISLAND RD APT 1 F OWNER'S NAME SEACORD POWNER ADDRESS 300 BUCK ISLAND RD APT 1F TEL 914-522-3481 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:Li RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD FIXTURES 7 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM p , , I I� : � _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ! 1 DEDICATED WATER RECYCLE SYSTEM DISHWASHER . DRINKING FOUNTAIN �i� l[ FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1 KITCHEN SINK LAVATORY II ROOF DRAIN SHOWER STALL SERVICE/MOP SINK 1 - TOILET URINAL a WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1.« _I. , WATER PIPING OTHER I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 0 LY: OWNER ❑ AGENT EJ 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 a ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mplia c with a P inent provisi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME FMARK MORAN LICENSE# 20786 SI A R MP❑ JPQ CORPORATION❑# PARTNERSHIP❑# r ..LLC❑# r.. :-; COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE t t_ s ; CITY FORESTDALE STATE MA ZIP 02644 TEL 508- 48- 93€Ep I j 2i� FAX CELL 508-648-2934 EMAIL MORANPANDH©GMAIL.COM PLEASE EMAIL BACK r 1 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 03,202 PERMIT# BLDP-21-001155 JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 1 F OWNERS NAME SEACORD CALEB J G OWNER ADDRESS SEACORD ELIZABETH J 1656 ORR TERR THE VILLAGES FL 32162 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Ei 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 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 Lark Moran LICENSE# 20786 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MARK R MORAN ADDRESS. 16 BRAMBLE BUSH DR, CITY FORESTDALE STATE MA ZIP 026441017 TEL FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Vile/sr; CITY WEST YARMOUTH } MA DATE 8/12/2020 PERMIT# l�G''i1+1 'Ob 1 Ls' JOBSITE ADDRESS 300 BUCK ISLAND RD APT 1 F I OWNER'S NAME SEACORD GOWNER ADDRESS 300 BUCK ISLAND RD APT 1 F TEL 914-522-3481 ?FAX a TYPE OR OCCUPANCY TYPE COMMERCIAL_M! EDUCATIONAL RESIDENTIAL _i.a PRINT CLEARLY NEW: RENOVATION: .__ ' REPLACEMENT: _/w' PLANS SUBMITTED: YES NO !,e APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER __. .. �� CONVERSION BURNER I COOK STOVE DIRECT VENT HEATER I ' DRYER I FIREPLACE l FRYOLATOR ___ _a _ I 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 i. OTHER _... INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E '1 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 ,,w, 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: WNER __...I 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 acc to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ' ce wi II Pe ' en provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER—GASFITTER NAME MARK MORAN LICENSE# 20786 SI NA MP _, MGF .,_ JP i JGF LPGI 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 4 EMAIL MORANPANDH@GMAIL.COM PLEASE EMAIL BACK