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HomeMy WebLinkAboutBLDP-23-000692 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u CITY YARMOUTH MA DATE 8/10/22 PERMIT# BLDP-23-000692 161 JOBSITE ADDRESS 15&17 ANGELOS RD OWNER'S NAME THOMPSON WILLIAM P P OWNER ADDRESS BROWN-THOMPSON MICHELLE A 17 ANGELOS RD SOUTH YARMOUTH,MA TEL 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 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/OIUSAND 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 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 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❑ 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 Joseph Halloran LICENSE 10984 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSEPH M HALLORAN ADDRESS 29 Forest Glen Rd CITY Hyannis STATE MA ZIP 026012537 TEL FAX CELL EMAIL sowdawg@comcast.net E SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' = u a ci MA DATE $ /d 2 Z PERMIT# 3 ��- j JOBS 'DRESS at i S f10 OWNERS NAME Hi£Mfll Q,73SG4/ ii !LOIN EPA' �� I:.,." RESS SgM2 TEL 77/-26g U 9" Ax TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL E PRINT �/ CLEARLY NEW:[ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES'1 FLOOR- 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 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET / 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[► NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY fir 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT I and terebt all ye�y that all of the details and information I have submitted or entered regarding this application are true a a to of my pkanbing work and installations performed under the permit issued for this application will be in is • a r vision of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. the PLUMBERS NAME Jv sip L U /c4 / LICENSE#/d9$/ IGNATURE MP[vf JP❑ CORPORATION❑# PARTNERSHIP 0# LC❑# COMPANY NAME Jo Sf Q L i, Jo, , PLUM 1jl N ADDRESS _2 7 Po k4 sT/Cj Lg�, /2 0/9 J CITY /� ref Nn,7/S STATE n9. ZIP d 2 fj a - - I TEL Sod ��'� 2 a37 FAX CELL EMAIL So wc4 t tJ 3 ) cc frtc4 T/', ,v ,F'7-