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Home My WebLink AboutBLDP-22-002984 ( rF MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY (YARMOUTH I MA DATE 111/23/21 1 PERMIT# BLDP-22-002984 wn; ' JOBSITE ADDRESS 18 JOSHUA BAKER RD I OWNERS NAME(Rosa Hemandez _ ( 1 P OWNER ADDRESS (TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:EaPLANS SUBMITTED: YES NO❑ FIXTIIRFS FLOORS— RSM 1 9 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: YES 0 NO 0 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. 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 1Robert Lalime I LICENS413701 SIGNATURE MP JP 0 CORPORATION ❑# I I PARTNERSHIP ❑# 1 1 LLC ❑# ( © COMPANY NAME 1ROBERT C LALIME 1 ADDRESS 1575 Main St CITY IMashpee I STATE IMA I ZIP 1026492054 I TEL I 1 FAX I I CELL I 1 EMAIL 'none 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 MAP: PAi2 ce t s.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK :7---r-:' AfNIMII CITY Ilar 1 P MA .DATE wzraf i e PERMIT# 2Z- 29 8`/ • JOBSITE ADDRESS t I g 'TO S It//A A 4 (A OWNER'S NAME', (O 3A /I&c SI'Ait b 3-2_ I P OWNER ADDRESS( I TEL! �,e,� ,FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL I=1 EDUCATIONAL 0 RESIDENTIAL IJ ' CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:g PLANS SUBMITTED: YES 0 NO❑ FIXTURES 1 FLOOR.- BSM 2 3 4 5 6 7 8 10 11 12 13 14 M M BATHTUB MI�'_�ME Miff 11.1[1.11_�'� �'�'S am CROSS CONNECTION DEVICE WOWEINIMIEswim um um limilm .am pin um DEDICATED SPECIAL WASTE SYSTEM _ 'j1 � , '' '' lillt' `�,'� DEDICATED GAS/OIUSAND SYSTEM —,lam —<'M Wpm 1 —' fationf DEDICATED GREASE SYSTEM �1.11-EMI �'Mr NM DEDICATED GRAY WATERRECYCLE SYSTEM ��_��_�_�� _�� _ ,It��11111111.�-Mg API DEDICATED WATER L I, 111111.117011:01111''� W Wilf IMO �� _, DISHWASHER1111111.111 MI MR MB I ,� DRINKING FOUNTAIN i '••�' I IT �� '. FOOD DISPOSER AM I— mOi—lou swim.I R FLOOR I AREA DRAIN 111111.1'�� KITCHEN SINK ��I INTERCEPTOR INTERIOR ��_ '�� LAVATORY -!',-:: - -_-- -'.- _I-. ROOF DRAIN ME11111111.111111111111111111111111WAN N;_Il_Mil MImg SHOWER STALL ��1= I' „ OWIIIIIIIIIM am MI.1.1111.111111 TOILET SERVICE I MOP SINK .'OM 0 r _INK INN URINAL JIMIJOINC11111.1111•.1111111110011.1111111.1 1111111111111111111, 111•11.11�',� WASHING MACHINE CONNECTION � i' �i omt ' I �� I WATER HEATER ALL TYPES �� v rim y!...„ In WATER PIPING ' OTHER 'm' ', ,�n.: � _ _ . -- - ;M no Ii,googom INK ,� 11111111111111111011111111111111111.1111— 0 MONItim Lim OM 11.1111..111.111101.1111111111011 MIN MN OM WANE am Wolin 1� ��_. imi -101111101011.111.11111111.— 111.11111111milow.,-*In micamilimunitilm off 111.11110.11IN NM 111.11.1. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ed 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 a�%-I epto the best poff oyn11f11111111 and that all plumbing work and installations performed under the permit issued for this application will be in complan.= Massachusetts State P mbing Code ar Chapter 142 of the General Laws. . / 2)�,0r Lw PLUMBER'S NAME • f ' t LICENSE# S NATURE MP Ill JPE] (�y / CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME I UCS pCU✓m (91 AM-9 I ADDRESS +r�+�.arr�+ul► AM' CITYl OCA SW"ea ISTATE[ VIQ 1 ZIP 0 ( 1 TEL . r� - i _I ! . �►ti��riii�ii��. FAX L t CEi1� EMAIL . 111.1.11.11111111111111' BUIL ` ' -t . NT bY - 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# ELAN REVIEW NOTES •FT' • • • • « A • . .