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Home My WebLink AboutBLDP-23-004781,_.,— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ./ CITY YARMOUTH MA DATE 2/28/23 PERMIT# BLDP 23 004781 JOBSITE ADDRESS 40 MELVILLE RD OWNER'S NAME WALSH JOHN N P OWNER ADDRESS 40 MELVILLE RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES 1 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❑ 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 Andrew Leighton LICENSE 1130 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.com I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WOR cry yt,,,y)06)- MA DATE 1.-1,9 7A3 PERMIT#.2; ti JossrrE ADDRESS i4/6 Me,/v-i/e OWNER'S NAMEIC5414 Ltali&,\ P OWNER ADDRESS " I' TEC 7 74/";gL, -301/4AFAxi TYPE OR OCCUPANCY TYPE COMMERCIAL 9 EDUCATIONAL 7 RESIDENTIAL PRINT CLEARLY NEW:i RENOVATION:-Li R1,77LACEIMENT::1--K- PLANS SUBMITTED: YES Li FIXTURES . FLOOR-. eat 2 3 4 5 6 1 7 • 8 9 10 1 11 12 BATHTUB _ _ _ _ _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTBA. DEDICATED WATER RECYCLE SYSTEM ME ,wwst MIK aumw111111111www mow DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN I I III INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN issel.ptioraut IMF Illit 111111111111111111114 RIM RIR it MK 1111111111110111tallitiNi SHOWER STALL airildr21111111 r SERVICE/MOP SINK Air TOILET • URINAL WASHING MACHINE CONNECTION 11111111111111 WATER HEATER ALL TYPES WATER PIPING OTHER i loot SW lit Miff lilt air aim off-amillit ilia mar as Milli 1111111111111111 INK • INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of filIGL Ch.142. YES JI NO E • -IF YOU CHECKED YES.PLEASE INDICATE THE-r/PE OF COVERAGE BY cHEcKING:niE APPROPRIATE BOX BELOW UABILITY INSURANCE POLICY . OTHER TYPE OF INDEMNITY 71 BOND Lj OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusem General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: ‘i AG SIGNAURE OF OWNER OR AGENT I hereby Certify that an of the detaBs and iiitoiiiiaLiwit I have subrniled or entered regarding this true tO my and that all piurrting work and installations performed under the permit issued forth!,applicator,will lei "Oil Massathissetts Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I ANDREW LEIGHTON LICENSE# 16130-M ' GNATURE MP I€.2 JP El CORPORATIONaliti 3734C IPARThERSHip !A U.Dal COMPANY NAME I HALL OIL COMPANY INC. ADDRESS, 435 RT 134 CITY!SOUTH DENNIS 1 STATE MA imPjoneo TEL 508-398-3831 I ; PAX Si1P-.1443068 I CELL I EMAIL I halialcomparAgrnalcorn