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HomeMy WebLinkAboutBLDP&G-22-006963 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK M;-__ci CITY YARMOUTH MA DATE 6/2/22 PERMIT# BLDP-22-006963 tr. JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 10D OWNER'S NAME OLEARY MARY LOU TR P OWNER ADDRESS ARSENAULT FAMILY IRR R E TRUST 300 BUCK ISLAND RD UNIT 10D WEST TEL YARMOUTH,MA 02673 TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURFS FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 i 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. PLUMBERS NAME Chris Poire LICENSEI28901 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 37 Calvin Drive CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber@gmail.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 • -:SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �1= CITY d'rY1 o va MA DATE .� �3--- Z'1 Cn . (_ ' _L r ' PERMIT# 5 20 BSrE 'DDRESS 3c �LLcUcl«1 1«l /Q"1) OWNER'S NAME :U IL Dp DEPARNIN , (DRESS TEL FAX Zy TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:©� PLANS SUBMITTED: YES El NO❑ FIXTURES Z 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/OIUSAND 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 • SERVICE/MOP SINK TOILET URINAL . j 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. YE NO 0 IF YOU CHECKED YES,PLEASE INDICATE THETYP OVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LI':IUTY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 OWN °'S I SURAN I AIVER:I a .1 1. - that the licensee does not have the insurance coverage required by Chapter 142 of the Mas •tts Ge • :I Laws,an. hat my sl;nature on this permit application waives this requirement. CHE ONE ONLY: OWNER 0 AGENT 2r. IGNATURE 0' NER OR AGENT I he -. - . that all of the det: and information I have submitted or entered regarding this applicatio a and accur the best of my knowledg. and that all plumbing work and installations performed under the permit issued for this application will b i Hance with inent provision of th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME f, I Pco'--e.—_ LICENSE# 3376� . SIGNATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME 2: r-C__ P H - ADDRESS 57 S�;ti ' d r s CITY e_ng i I " ` DS STATE2'L ZIP O2 6 0 ( TEL 2 7 �� J C C1,c r �Y / FAX CELL 7 7 tl 9? b y.6 l EMAIL �{ 1t�m} ,,-�.� q� 6mcl 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 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 02,2022 PERMIT# BLDP-22 006963 i; JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 10D OWNER'S NAME OLEARY MARY LOU TR G OWNER ADDRESS ARSENAULT FAMILY IRR R E TRUST 300 BUCK ISLAND RD UNIT 10D WEST TEL YARMOUTH MA 02673 TYPE OR OCCUPANCY TYPE COMMERCIAL �1❑ RESIDENTIAL ❑ 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 0 OTHER OF INDEMNITY❑ BOND ❑ OWNERS 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 Chris Poire LICENSE# 33901 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 37 Calvin Drive, CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber(a),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 • �, � �t E •+- USETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •o6F CITY CI ov4-� MA DATE c 1/ PERMIT# - (o i`3 �-~� �aI t � AY ?�r,J ) �AlAm R:SS 7 60 " l� J-S te-• Oil i O OWNER'S NAME ING ) iwitektF':„S TEL F"Y, By: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 116 PINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES FLOORS—• KM 1 2 3 1 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER j CONVERSION BURNER —~ COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST • _ UNIT HEATER INVENTED ROOM HEATER WATER HEATER / OTHER _ 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 ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA .BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ • O. 'S I ' DICE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the as•.chu• s General Laws,and that my signature on this permit application waives this requirement. • `/ CHECK ONE ONLY: OWNER ❑ AGENT ❑— SIGN JT RE OF OWNER OR AGENT '�. ereby certify that al the details and information I have submitted or entered regarding this application are tr and urate to e st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co p nc ith all P i t provision of th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE#✓'9li1 SIGNATURE MP ❑ MGF❑ JP JGF❑ LPGI❑ CORPORATION❑It PARTNERSHIP❑# LLC❑# COMPANY NAME i/Q i ? 1 C. _ ADDRESS 37 $a'r �(�e, 1 5 CITY 4-1 UGinr S / STATE Ple, ZIP d TEL FAX CELL 7)`i $3G CtI Li EMAIL 01L�ill,,ywbe ' � Nao) ---- ------ -- -- -- ------------- ---- --------•- --- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY I+INAI INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑• • ❑ • FEE: $ PERMIT# PLAN REVIEW NOTES • • •