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HomeMy WebLinkAboutBLDP-22-001123 { MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK , _o CITY YARMOUTH MA DATE 8/30/21 PERMIT# BLDP-22-001123 t' JOBSITE ADDRESS 12 BISCAYNE AVE OWNER'S NAME BLOOMER AIDAN P OWNER ADDRESS BLOOMER CATHERINE 12 BISCAYNE AVENUE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO El FIXTURFS • FLOORS—I 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 Michael Mcbride LICENSE 1+8681 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# r LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES E PERMIT# PLAN REVIEW NOTES r v MAP: PRI2e6C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK AIIIII _=1,��' CITY MIN v1 EaralliniMA DATE ` 1#7A7a PERMIT# 22- t t 13 JOBSITE ADDRESS /9 hirgite,/gfieie I OWNER'S NAME A Al ,J !f)® P .OWNER ADDRESSL - 7 I TEL 5T3 •-)----ch 6 AFAX 111111111111111 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:IDRENOVATION:❑ REPLACEMENT:a PLANS SUBMITTED: YES❑ NOW FIXTURES Z FLOOR BSM 1 2 3 4 5JI�6 7 8 9 10 r 11 12 13 14 BATHTUB .� ''.I�J'�, _ .N1 NM UM :', CROSS CONNECTION DEVICE �l _i�I .L 1i �M'IM'I�jIMi DEDICATED SPECIAL WASTE SYSTEM �JI�1 LI r�N `�L�I�II�LME;DEDICATED GASIOIUSAND SYSTEM lam: DEDICATED GREASE SYSTEM i0finli�� il INN mrime-Am Am DEDICATED GRAYWATER SYSTEMY11'; 1I { W I[ 1.,,I�;� NEI DEDICATED WATER RECYCLE SYSTEM 1��� J DISHWASHER ,,�I , I I i ' 01101111111111.11101111•11111 OM 1111111.1101111. DRINKING FOUNTAIN ii �j ME.1111 IIMI FLOOR/AREA DRAIN01110.001.111.1•1111.�i� J "�I, WI ' kI, FOOD DISPOSER � — WIPP I�,I— O - !- imr pm=Mr Not A INTERCEPTOR(INTERIOR i��a�iI���I�' =�'��' �� INM,�'�I,I m. KITCHEN SINK 011.1.1•111.1141.11111,111111.11111 r MIK LAVATORY hi�� ,I�I�,I�I�����L��:�I�owns ROOF DRAIN l I il,'� r ..1.11.111 �;;� SHOWER STALL I � ' �I a '!' ARCIONI,Mx NM_ SERVICE/MOP SINK 01.111111.1.1.101.01.101011.0111111101111 TOILET1.111-10111.1111111111111111111110111111110•0011111.11111 MAK I ' URINAL I_�i ' , WASHING MACHINE CONNECTION 11111.1W WATER HEATER ALL TYPES **J M 1111111= ma PIPING _ .11 !I al iI lt1�IrW!I► iif11�1�Iii Mi ! OTHER ,iI ',I .I Ma _ I* .n'I it L-4�...�t ai tIIIwM.—.';a'. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES til NO ❑. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY tiZI 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 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 Plumbini Code and Chapter 142 of the Gen IILLaws. \ ' /'� il ` `� PLUMBER'S NAME r.k pL ( f• ;( 'LICENSE# r� .;7..0 vl 1C" SIGNATURE '�.X MPD JP at_ CORPORATION D#17Mbi PARTNERSHIP 0#UMW LLC 0#MOM COMPANY NAME NIS (3{ (rJ , 14 1 ADDRESS 9 U , ( oft, CITY • / STATE` 4 ZIP Q Z( ? I TEL 7 7 '/ 7/n 9/ 7 a_ FAX` 1 CELL.1 1 EMAIL A ' " Ii !• /r . _. ' 1 A. a ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: S PERMIT# PLAN REVIEW NOTES fi 0401 44011• ' 4 A •f