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HomeMy WebLinkAboutP-18-6277 _r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/8/18 PERMIT# BLDP-18-006277 JOBSITE ADDRESS 30A SALT MARSH LN OWNERS NAME WALL THOMAS A P OWNER ADDRESS WALL JOAN M 661 LOWELL ST UNIT 6 LEXINGTON, MA 02420 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO 0 FIXTURFS 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 LAVATORY 2 _ ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 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 0 NO 0 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 0 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'S NAME David Neal LICENSEI#3746 SIGNATURE MP © JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DAVID G NEAL ADDRESS PO BOX 218 CITY S YARMOUTH STATE MA ZIP 026640218 TEL FAX CELL EMAIL no ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES • • Yes No THIS APPLICATION SERVE AS THE 0 0 neeuir FEES$ PERMIT I _ PLAN REVIEW NOTES gl , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK W.; CITY `f f} d dYt1 I DATE 1,47/17/Pc I PERMIT# 73LDP- - G7}6 a77 JOBSITEADDRESS ,30/1 S4'-rfArea 44•r/r I OWNER'S NAME 77/4 [&VEP_ I ' P .OWNER ADDRESS SAvfE I TELh/7$/Sr-a723IFAX — TYPE OR OCCUPANCY TYPE COMMERCIAL CI EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:Ig REPLACEMENT:Q PLANS SUBMITTED: YES 0 N0,2 -BATHTUB 7 FLOOR-, BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB .I .. f a_i S If l -'r CROSS CONNECTION DEVICE , I 'n DEDICATED SPECIAL WASTE DEDICATED GAS/OIL/SAND SYSTEM liIli i '. r L DEDICATED i DEDICATED GRAY WATER SYSTEM iJ ' � . � DEDICATED WATER RECYCLE SYSTEM _ - S -T1DISHWASHER a _ FOUNTAINDRINKING _ I FOOD DISPOSER I6JsJf .L_ S FLOOR/AREA DRAIN - _S1 =IOW !KIITCHEN TOR SIOKINTERIOR) / , J , V TORY °----e � ./ l 6 LAA n 4 __ 1 ROOF DRAIN ' __ WI �i SHOWERSTALLSERVICC �� ti t1b �" I i TOILETEIMOPSINK h t :. - I '- f .r' URINAL 1 I _ _ I .,._ `n : WATER HEATER ALL TYPES j ' WASHING MACHINE CONNECTION I��,� . I �! �.���, '���'—= r WATER PIPING :- _.1� a i� ! Jr , OT- I �a II a i l��tli i ... i-' S ._ r l _. _ — [ �l _ • 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❑ 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 lam_ /.4.."4•••-•-•....... CHECK ONE ONLY: OWNER ErAGENT 0 SIGNATURE OWNER OR AGENT I hereby and that allcertify p u plumbing all and installations performed under the permit Issued for rmation I have submitted or entered this applicatong this nplication win be In •e true and the best of of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • di .11 •PLUMBER'S NAME DMJIn Crarellin/1EtL ILICENSE#I I 7941 SIGNATURE • cJP❑ CORPO COMPANY NAME ,5(-Cg I ADDRESS /'"p Acpc a I I CITYl,C.yA,eJ-/OUttI ISTATE I /ff ZIP d �-6, (n 7 I TEL row �i3✓ -09/7 ' I • FAX / I CELL i EMPJL ' I I • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes �j� • THIS APPLICATION SERVES AS THE PERMIT ❑ 0 ,,c&yQ r/ ` Al / PitS b IU� FEE: S PERMIT1 (/ 6,/277e b / /4L 57 ;-71.3- PLAN REVIEW NOTES • • 4 50 hiJt eSit • • • • • • • w ► . . • tj s,r' Accela Citizen Access Page 1 of 1 .—k • • AMouncement. I Realater for en Aowgg[I lag Need Help?For technical assistance In using this web application,please call the ePLACE Help Desk Team at(844)733-7522 0fir or(844)73-ePLAC between the hours of 7:30 AM-5.00 PM Monday-Fdday,with the exception of all Commonwealth --� and Federally observed holidays.If you prefer,you can also email us at ePLACE helpdeskastate ma us.For assistance with non-technical issues,please contact the issuing Agency directly using the links below. Contact Alcoholic Beverages Control Commission Contact pivision of Capital Asset Management and Maintenance Contact Department of Labor Standard Contact Division of Professional Licensure • Translation Information-Click Here To apply for an Energy and Environmental Affairs(DEP,MDAR or DCR)permit or license,please click here. Document Attachment:In order to upload required documents,this system requires Microsoft Silvedight,which can be downloaded for free km, Convenience Fee:Please note there may bee convenience fee for all online credit card transactions.Thera is no fee for online payment by check. Home Manage Llcen..s,Permits B Certificates File 8 Track Complaints Please refer to the Licensing Entity's webnta for additional information regarding the status ant discipline Information shown below. For DPL IMomtabon,please wit the DPL wabede. For ABCs information,please wed the ABCC webatt Information Pertaining To: Master Plumber 13748 Licensee Detail License Number' 13746 Licensing Entity: Board of State Examiners of Plumbers and Gas Fitters License Type: Master Plumber Type Class: M License Issue Date: 01/21/2005 License Expiration Date: 05/01/2020 Status: Current Current Discipline: Prior Discipline: Name: DAVID G NEAL Business Name: DBA Name: 1 Public Documents https://elicensing.state.ma.us/CitizenAccess/GeneralProperty/LicenseeDetail.aspx?Licensee... 5/8/2018