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Home My WebLink AboutBLDP-22-000014 , Q-r 1 �' L J!T a i,., 11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - -E, CITY YARMOUTH MA DATE 7/1/21 PERMIT# BLDP-22-000014 1 6 JOBSITE ADDRESS 57 STANDISH WAY OWNER'S NAME PMG Realty P OWNER ADDRESS 57 STANDISH WAY WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:El 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER 1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL 1 1 SERVICE/MOP SINK TOILET 1 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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❑ OWNERS 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 Steven Trail! LICENSE 21392 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC El# COMPANY NAME STEVEN J TRAILL ADDRESS 178 MALDEN ST CITY MALDEN STATE MA ZIP 021486519 TEL FAX CELL EMAIL ti 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 ` .`.!C) _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK LI I Ilan — CITY �J�Lh'l D jJ T"J4 MA DATE /n PERMIT# om. Nj� c Q JOBSITE ADDRESS S rI 497P I' I Sit CW OWNER'S NAME fil I cn ' OWNER ADDRESS L of L'1 44. IR/MI5 TEL FAX_ ° 1z 1 (V —, TtEEI � DR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL E CLEAP LY NEW: E REN OVATION:Yr REPLACEMENT:E PLANS SUBMITTED: YES❑ NO FIXTURES Z FLOOR--F 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 SYSTEM DISHWASHER / DRINKING FOUNTAIN _ _ FOOD DISPOSER / FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / f I LAVATORY / 1 ROOF DRAIN SHOWER STALL / / SERVICE/MOP SINK TOILET 1 / URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ' WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[Y1/ NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 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. F= CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I` I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a urate to the best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance all Pertin nt nr inion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. N 'I PLUMBERS NAME LICENSE# e' 139 SIGNATURE MP ❑ JP[f RATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME 3)04./&.11 ) rt;,i L.c- ADDRESS /9S/ Ma kie '1 s! CITY PIA A[L'`pSTATE ept ZIP 921 TEL �'�112.1147�I FAX CELL EMAIL • • Cri O z Gzqf U 4 Z z >�El o a W o z U = om— a Li) - O ¢ d t w O LU Q O zo cK rzal � U r co CLi S W H W Er) 0 z 0 U z 0 0 71-e,Uen Tai"/ ai39a _ In geprris Puff) in9 Peon i r y wesr VARirevm) two J,,kE' 7 oIncEL m yS�RYr;i T' 71-) V1/62Eiry icor e51- 431g T f)7i /Sly 7FIF -N76-8 r • r ' l� y \ AUS 13 2021 4 � "Bli`LU1NG DEPARTMENT by ___________________----- ___— e U . _� 1 _ , f 1 .