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HomeMy WebLinkAboutBLDP-21-006913 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w�. r` CITY YARMOUTH MA DATE 5/28/21 PERMIT# BLDP-21-006913 0,,_lJOBSITE ADDRESS 21 TRUMAN LN OWNER'S NAME DONAIS JEFFREY A P OWNER ADDRESS DONAIS MARGARET E 56 RIDGE RD SOUTH HADLEY,MA 01075 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES 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/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 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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. 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 Mark Moran LICENSE 20786 SIGNATURE MP 0 JP © CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK R MORAN ADDRESS 116 BRAMBLE BUSH DR CITY FORESTDALE STATE MA ZIP 026441017 TEL FAX CELL EMAIL 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .__ CITY WEST YARMOUTH MA DATE 5/06/2021 PERMIT# O 9 tib-Uo( i 1 3 JOBSITE ADDRESS 21 TRUMAN LANE OWNER'S NAME JEFF DONAIS OWNER ADDRESS 21 TRUMAN LANE TEL 413-531-9953 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB IMO all I_I_I_I_I_1_I1.111®®�_ CROSS CONNECTION DEVICE _;_,_,__1_I_EIS__1___,_ DEDICATED SPECIAL WASTE SYSTEM ME 011,I_r■■•r O__[111111111=11111.11 I_I_01111 OM NM DEDICATED GAS/OIUSAND SYSTEM 011.1.1M T NM _ME IME DEDICATED GREASE SYSTEM _11101.1 INN 'MEM MUM VIM__I_,_'_ DEDICATED GRAY WATER SYSTEM I_ NMmo No®_I_Immo (_mow DEDICATED WATER RECYCLE SYSTEM _I_ Ulm DISHWASHER 11.1_i_ MEI 111111111111111111111111111111111111115_NOM DRINKING FOUNTAIN N__I_______I _r_ FOOD DISPOSER "Mil=I_ INE I__ I__I_I_I_M._ FLOOR/AREA DRAIN I_I_I__I__''_I_!_____ INTERCEPTOR(INTERIOR) I_I___I_INN MS MOM Sini®I=OM Mini UM ES KITCHEN SINK I®I_EMI I_1_1_''_i__I_ ® LAVATORY I_I_ IMMII ON _I__0111111111,11111111111111 ON MEI I_ ROOF DRAIN _____iI_— SHOWER STALL MN 1_I_1111111M r_I_ 1110111111111_I_I_ _r_ SERVICE/MOP SINK 1_ __ Imo;_111111111111111 h IIIIIIII I_r® _i_ TOILET _BM;_I_®__,MIN_i_', MIMIMEI URINAL I_ _UM MEMO NMI i_!■110II_h1_INN_i® h�_I_�_;M__INMN�I® WASHING MACHINE CONNECTION I_01.1011.,_i_ WATER HEATER ALL TYPES l0�'_ NM WATER PIPING _ _MIN_S_r_,MOM_11111111 MIMI MIMI MN MIR I_ OTHER _h-_1MMI_NMI'i_;_I__1®I®i■_►_`N 111111 1111111 ISM NMI MEI 11111 EMI MEM MINI IMMO=IIIIIII MIN MUM ___I_I_1111111MEI I__111111111111111111111111M I. _ EMI I_INN(_'-__I__MEM I_I__U_ 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 Q 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 0 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, -te 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 •p iance all Pe ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i ✓_;;9.d f14/,, PLUMBER'S NAME MARK MORAN LICENSE# 20786 IGN:TU'E MP❑ JP I=1 CORPORATION PARTNERSHIP 0# LLC❑# COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934 FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM % c &VA.( I 1)1 CK 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