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HomeMy WebLinkAboutBLDP-22-002878 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK eq CITY YARMOUTH MA DATE 11/18/21 PERMIT# BLDP-22-002878 d` JOBSITE ADDRESS 335 ROUTE 28 OWNER'S NAME ZAMBELIS EVANGELIA TR P OWNER ADDRESS Y HOUSE REALTY TRUST 335 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES El NO❑ FIXTURFS FLOORS—* RSM 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 2 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 0 OTHER TYPE OF INDEMNITY❑ BOND 0 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 Michael Mcbride LICENSE 1)8681 SIGNATURE MP ❑ JP Q CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# COMPANY NAME (MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE IMA ZIP 02673 TEL I FAX CELL EMAIL Istinger.mcbride@gmaii.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES i . i y,,g-rAi o r- Hi HO v se mAP. PAR E C . „k-vg- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _v-'-:1 tip- 71,131 ',..‘1---------:,:, CITY IEIFAIFrrdIIIIIIIIIIIIa MA DATE 1111101.11201 PERMIT# JOBSITE ADDRESS OWNER'S NAME Vj C/TES )/,n04 4,ill s' I P OWNER ADDRESS , 4 ., if .' A TEL 3 to V-727 SIM L TYPE OR OCCUPANCY TYPE COMMERCIAL 21 EDUCATIONAL ❑ RESIDENTIAL❑ PRINT PLANS SUBMITTED: YES❑ N0� CLEARLY NEW:ElRENOVATION:❑ REPLACEMENT:WI FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB m!MI' II '.='i 1l x , '- 1—;OM INI!IIINC� CROSS CONNECTION DEVICE 11.11111/1.11111111.111111111011WIWW IM WW1.=Wit DEDICATED SPECIAL WASTE SYSTEM 111.11111111111111,1111.1.11.1111 FOOPIIIIIIIISI WIWIDEDICATED GAS/01USAND DEDICATED GREASE SYSTEM STEM Talliall.1111111011110.11 11111.11111111.011 NM WINCIIINI Om i I � i W '����NIIIOM DEDICATED GRAY WATER SYSTEM mai mil um lost..� ''�- k !ow'imi .' DISHWASHER 41111111111�, J� W, 'L i�� �WWWINW h: DEDICATED WATER RECYCLE SYSTEM 4 i OW 01111.101.11.11111.11111.1.11111.111110111111 MN U DRINKING FOUNTAIN 111,1111.W.111111.11111111111.111. 111,` WW P.111.11''WI FOOD DISPOSER ���WWWW W 1111.WWWW.PINNiIII WI FLOOR/AREA DRAIN M. W.P 11111111111.'NW INTERCEPTOR INTERIOR 0111011.0111.111111.1~111111,MINIANII !f l 'NM Ali SW' KITCHEN SINK .OM ', ! NMI 'INN IIIIR '. LAVATORY I ,.WWW iA WW WWWimilm mil= ROOF DRAIN � III ' '� � ' I SHOWER STALL I ilk NWO I_; ' pomp.iw, SERVICE/MOP SINK 111.1.1.1W10.111 IU UI•�, l; it ' '1 ' 1M', TOILETLIM .-111.111.1iiii � � 'iJillWig.I� U ___ __ URINAL l�i�'��i WASHING MACHINE CONNECTION W111.11111.111VIIINI11111111111 MRI 1111111 PIPINGW , WATER HEATS I 11 L'Ui WATER HEATER ALL TYPES � �� _ � �'� ���iii — <� 'I 'a! a i 1I IIIIII 111.0111.01.11111111.111 OTHER11111111111111.111111111.11.111.1111.111111.111 �� — __ i ;li• ' it ii 1 i _ —_.—.Y.�_�__ -I, - : it • l !,; ': ' ;I ,; UIl INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES WI NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY VI, 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 accurra�te too the�ebest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in�with�. Pertinent \rn�provision of the Massachusetts State Plu bing de and Chapter 142 of the General Laws. . PLUMBER'S NAME I (1,P 11"Ir j I SQ 1 LICENSE#Van SIGNATURE MP JP _ A CORPORATION❑# PARTNERSHIP❑#I (LLC❑#F ♦ iQ COMPANY NAME I,. i"M c)3r)�J . J4-4, ( ADDRESS "i 7 rem.,/, /4 n(1Q f CITY 1� .r 1l./1 �, 'S 'V VV 1 STATE 1 ZIP 0 7106 / I TEL�r' j i FAX o CELL j EMAIL TL - - t� I �. ... . . . . ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I 4 « '3. 'dra� rgiR ivp « • suo-