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HomeMy WebLinkAboutBLDP-21-006856 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y=='cCITY YARMOUTH MA DATE 5/25/21 PERMIT# BLDP-21-006856 1;- JOBSITE ADDRESS 104 PLEASANT ST OWNERS NAME GREENE MARJORIE J TR(EST OF) •� OWNER ADDRESS GREENE PLEASANT ST RLTY TRUST 40 CROSBY ST SOUTH YARMOUTH,MA TEL 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 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 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 3 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 OTHER 1 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 El OTHER TYPE OF INDEMNITY El BOND El 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 john gilmore LICENSE 18699 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PLEASANT BAY PLUMBING INC ADDRESS CITY BREWSTER STATE MA ZIP 02631 TEL FAX CELL EMAIL PLEASNTBAYPLUMBING@COMCAST.NET ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES S PERMIT# PLAN REVIEW NOTES I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ ,i, CITY/TOW'>l4 *Q L. MA DATE ,Sy�2.4 PERMIT# JOBSITE ADDRESS 161-1 OWNER'S NAME&C` ‘ti - POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:a. RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES,T NO❑ FIXTURES 7 FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB j CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _75- ROOF 5ROOF DRAIN SHOWER STALL I SERVICE/MOP SINK TOILET f URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING f OTHER CIwF s46a-__ { INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 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 ..s1.:0111.6,-,to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co �.li- c -11 e ' ent provision of the Massachusetts State Plumbing- Code and Chapter 142 of the General Laws. • ` ` , tirg PLUMBER'S NAME• -�.L � �'-�"'L �- LICENSE# ���Icj %; SV' 'URE MPS JP❑ CORPORATIOIIK1# ( �`{$Y PARTNERSHIP❑# LLC❑# COMPANY NAME CIE `-\-- C ADDRESS � �•� � ��` ��C C CITY ,c7 � ��=S STATE V~'t\--ZIP 6 2_C �� TEL FAX CELL EMAIL \F �c>\u.