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HomeMy WebLinkAboutBLDP-23-005705 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,, aI CITY YARMOUTH MA DATE 14113123 I PERMIT# BLDP-23-005705 '" OWNER'S NAME MEANY MICHAEL J TRS ifIa JOBSITE ADDRESS 39 OUT OF BOUNDS DR p OWNER ADDRESS MEANY HELEN TRS 39 OUT OF BOUNDS DR SOUTH YARMOUTH,MA 02664 TEL P TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES 1 FLOORS-4 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 1 DRINKING FOUNTAIN _FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 El 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. I LICENS�3R655I SIGNATURE PLUMBERS NAME (Anson Celin MP 0 JP © I CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC El# I I COMPANY NAME IANSON CELIN I ADDRESS 126 Capt.Blount Rd CITY South Yarmouth STATE It ZIP 102664 I TEL I I FAX CELL EMAIL Iansoncelin@yahoo.com I A MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK "_ CITY ,t.Mifil yofetcYtdek MA DATE (-I' ''Z PERMIT* P— 5 7O 5 JOBSITE ADDRESS `3 1 Gl/ll- OF elinc Vr OWNER'S NAME/hK:WevJ MAISey P OWNER ADDRESS 5/ G c rl Rtitirk44 Or TEL 7 /5 -FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL 0 PRINT T/ CLEARLY NEW:❑ RENOVATION: REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO L FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 8' 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE , DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR I AREA DRAIN _ _ INTERCEPTOR(INTERIOR) KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL • SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: l { 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 INDICATE7YPE 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement.tt CHECK ONE ONLY: OWNER 0 AGENT 0 Z. SIGNATURE OF OWNER OR AGENT L 1 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 mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# 2c Ste- SIG MP JP CORPORATION❑# PARTNERSHIP❑.# LLC 0# COMPANY NAME CC/0 OW n, ADDRESS 2.6 C('vil ilk CITY Sl1n-tfi yomt STATE ZIP a`f 1, TEL FAX CELL 5 -24 0- I f7.2-- EMAIL Sun C.e l r fi[`�y.,, icctoL c-'-‘