HomeMy WebLinkAboutBLDP-21-004854 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-TvT , CITY 'YARMOUTH11/4
MA DATE 2/26/21 PERMIT# BLDP-21-004854
ti JOBSITE ADDRESS 67 BALSAM WAY OWNERS NAME QUIRK RICHARD M JR
p P OWNER ADDRESS QUIRK NANCI L 67 BALSAM WAY YARMOUTH PORT,MA 02675 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El
PRINT
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO CI
FIXTURES FLOORS-0 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 1
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION 1
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❑ 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 (Peter Hassett I LICENS4#1682 I SIGNATURE
MP 12 JP CI CORPORATION
CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I
I
COMPANY NAME (PETER J HASSETT I ADDRESS 18 Skipper Lane Hassett Plumbing&Heating Inc.
I STATE IMA I ZIP 102675 I TEL 1 I
CITY (Yarmouth Port I
FAX 1 1 CELL 1 1 EMAIL Ipeterjhassett@gmail.com
" f� P 3y
- — , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
7 '= MA DATE 2/26/2021 PERMIT# ��fl P_ Z(— &
^Iff CITY Yarmouth
JOBSITE ADDRESS 67 Balsam Way Yarmouth Port 4 OWNER'S NAME Richard M.Quirk Jr.
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
PRINT PLANS SUBMITTED: YES NOQ
CLEARLY NEW:0 RENOVATION:Q REPLACEMENT:Ej
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 l � I
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM BS_.�, '� "``
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM , inniinninn
11.
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER 1111111,11.11 OM NM 11.11111111111111.1111
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR 1
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1 !
SERVICE I MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION Er
WATER HEATER ALL TYPES (.._ ,., _
WATER PIPING i i
OTHER I
' Y ..
I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Li NO
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.
CHECK ONE ONLY: OWNER 0 AGENT LI
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
' .p.vision of the
and that all plumbing work and installations performed under the permit issued for this application will be in lia th -
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Peter J Hassett LICENSE# 11682_u__ _F SIG TURE
MPQ JP CORPORATIOND# 3506 PARTNERSHIP Q#
Lc Q#
COMPANY NAME I Hassett Plumbing and Heating,Inc. I ADDRESS 8 Skipper Lane
r
CITY I Yarmouth Port STATE MA ZIP 102675 TEL 508-744-7555
FAX 1. ._ 1 CELL 508-237-2175 EMAIL peterjhassett@gmail.com