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Home My WebLink AboutBLDP-22-000851 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK cr CITY YARMOUTH MA DATE 8/16/21 PERMIT# BLDP-22-000851 JOBSITE ADDRESS 86 WIMBLEDON DR OWNER'S NAME MORAN ELAINE P OWNER ADDRESS 4 WHIFFLETREE RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Michael Mcbride LICENSE t9681 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES S PERMIT# PLAN REVIEW NOTES • MASSAC USETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CIN , MAIM - 1 :?' MA DATE ZPERMIT# 27- ^2 r( JOBSITE ADDRESS I( 4.),0Yi p de-214 Oriv4 OWNERS NAME17 OWNER ADDRESS r PP( ± M Z%L `7 ?Pt FAX r P rifri of TYPE OR OCCUPANCY TYPE COMM CIAL 0 'UCATIONAL ❑ RESIDENTIAL a, PRINT CLEARLY NEW 0. RENOVATION:0 REPLACEMENT:g . PLANS SUBMITTED: YES 0 N9 FIXTURES Z FLOOR-► BSM 1 1 2 3 4 5 1 6 1 X 8 1 9 10 11 12 j 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM f DEDICATED WATER RECYCLE SYSTEM J DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN r INTERCEPTOR(INTERIOR) �--� KITCHEN SINK C �r1 - j LAVATORY • ROOF DRAIN - _ SHOWER STALL SERVICE/MOP SINK TOILET Bust nirvc- - - URINAL I 13y 1.1 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / WATER PIPING OTHER i • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142.. YES IX NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Xi OTHER TYPE OF INDEMNITY 0 BOND 0 i 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 apVication waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 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 m and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a Pertinent provision edge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. S., ` of the .!v PLUMBER'S NAME A I cttke ,c..8 f ,I LICENSE#/Va./. L SIGNATURE MP 0 JP 0 CORPORATION 0# PARTNERSHIP❑.# LLC❑# Prop, COMPANY NkMF Al _11° h aid' ADDRESS ? du 51 /c 6 r ,(, CITY G Pin (�(J i+' " f STATE ZIP L)?.Q 73 TEL , 0____/____,2„,_ FAX CELL , , EMAIL 5./iP/`';yl C ccio 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 . i . I f i