Loading...
HomeMy WebLinkAboutBLDP-21-002991 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ei CITY YARMOUTH MA DATE 11/25/20 PERMIT# BLDP-21-002991 t' �G JOBSITE ADDRESS 321 PINE ST OWNER'S NAME BREESE PROPERTIES LLC P OWNER ADDRESS 411 EAST CRESCENT PL CHANDLER,AZ 85249 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW: 0 RENOVATION:Q REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 2 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 1 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING OTHER 2 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q 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 0 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 John Gilmore LICENSE 13699 SIGNATURE MP © JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PLEASANT BAY PLUMBING INC. ADDRESS 43 B Independence Way CITY Brewster STATE MA ZIP 02631 TEL FAX CELL EMAIL pleasantbayplumbing@comcast.net • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES . ,N„g il ____ ___ I 1/4 "'>= cITY/TOWN \i R k MA DATE L1 12 J2-o PERMIT#&Pa-• J"OV LIP,/ JOBSFTE A DFESS 3 A' V 0(----C1-- OWNERS NAME ----1---G--“- c�-SG— POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL v PRMNT CLEARLY . NEW:0 FENOVATION:(121-- REPLACEMENT:0 PLANS SUBMITTED: YES®. NO 0 FIXTURES 1 FLOOR-, '' BSM 1 * 2 3 4 5 , 6 7 8 9 ; 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM , DEE/GATED GASKM.JSAND SYSTEM ' DEDICATED GREASE SYSTEM , • DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER - i DRINKING FOUNTAIN FOOD DISPOSER . FLOOR t AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK . LAVATORY , 'I ' 2 , ROOF DRAIN SHOWER STALL SERVCE/MOP SINK , TOILET •I 4.- URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES h WATER PIPING 3,.,_ ' OTHER c � , L JRANCE COVERAGE: - I have a current liability insurance policy or its substantial equivalent which meets the req eats of MGL Ch.142. YES ( NO 0 F YOU CHECKED YES,PLEASE INDICATE TIE TYPE OF COVERAGE BY SIG TIE APPROPIELATE BOX BELOW LIABILITY INSURANCE POLICY t-- OTHER TYPE OF INDEMNITY❑ BOND 0 OWNER'S INSURANCE WAIVER:I an aware that the licensee does not have the 11611111110)coverage required by Chapter 142 of the Massachusetts General Laws,and that my signage on this permit apphicalion waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT I and that plumbing work installations performed under the perm*issued for a�pp�ic anon(*Kik that all of the details and infonnation I have submitted or entered regawbig this application atom re Fet- a!� --fr, my of knowledge Massachusetts State Plumbing Code and Chapter 142 of the General taws. 1 PLUMBER'S NAME XJ S. G2k v..Ctt, LICENSE# 1.3 G?1 '1 r,ATURE MIWI JP CORPORATI �� PARTNERSHIP 0 it LLC❑# . ` COMPANY NAME 7 � ADDRESS (4 3� -�A64. er �' CITY \ STATE - ZIP 0 2-6 31 T EL ?7 Li`72-›= FAX CELL EMAILfC_AcS.Aesk-\4.k--2O' .(•,C�ti—s. �Z