HomeMy WebLinkAboutBLDP-22-000601 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 8/3/21 PERMIT# BLDP-22-000601
JOBSITE ADDRESS 101 SISTERS CIR OWNER'S NAME David Whalen
P OWNER ADDRESS CUMMAQUID,MA 02637 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW: El RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
FIXTURES FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 __12 13 14
BATHTUB 2
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 2 2
ROOF DRAIN
SHOWER STALL 1 1
SERVICE/MOP SINK
TOILET 2 2
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER 1
WATER PIPING 1
OTHER 1 _ 2
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND El
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 Robert Lalime LICENSE 13701 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ROBERT C LALIME ADDRESS 575 Main St
CITY Mashpee STATE MA ZIP 026492054 TEL
FAX CELL EMAIL none
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RECEIVED
.1,17,71
,'� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERI5ORM PLZUMS'Ihi�WORI j
� _/ !,] , MA -DATE!7 /7 a G' Z r P TIviING UAKEVNT
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CITI' 'O(t �CJ 1/"1
JOBSITE ADDRESS (O ( S I S I ?c'- C( (1- OWNER'S NAME _ At✓iis W✓ L.IA
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P -.OWNER ADDRESS 55✓►^-tr TEL IFAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ® RESIDENTIAL
PRINT
CLEARLY NEW:[IA RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES Q N00
FIXTURES 7 FLOOR-0 BSM 1 2 3 4 5 6 7 I 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE i
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM _ _
jai
DEDICATED GREASE SYSTEM 1 ` 'J
DEDICATED GRAY WATER SYSTEM ��
,„,...
DEDICATED WATER RECYCLE SYSTEM I
1` '!-
DISHWASHER J
DRINKING FOUNTAIN
__,. _
FOOD DISPOSERr,
FLOOR/AREA DRAIN
illinffratillir
INTERCEPTOR(INTERIOR) J'
U ,
KITCHEN SINK
'' r -_
LAVATORY
ROOF DRAIN a _
SHOWER STALL �._ _ti. _ "I■■ � ri
SERVICE/MOP SINK iiiimmaiinnumiriller
TOILET i L :' L
i
URINAL i i I
_f
" �.__, �__ F
WATER HEATER ALL TYPES M _ '; _
E
WATER PIPING ��'�I
i
OTHER � IOC � ���Aal�lt�� � F�� ����' i
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 Q OTHER TYPE OF INDEMNITY[3 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 ® AGENT ID
. 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 accu the/best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance ' Pe ' prmjsipn of the
Massachusetts State Plumbing Code a Chapter 42 of the General Laws. ���'
r3 it rr �
PLUMBER'S NAME �` LICENSE# 13�d ;GNATURE •
MPL' JP® CORPORATION # - 1PARTNERSHIP❑#, D 1LLC # - J
COMPANY NAME ()CL- •('L (.Qt,W , ,ADDRESS 1 ciS lWAt!k-i S'T
CITY Oti4.S L t 1 STATE £ + I ZIP 0 6? ,) ( TEL o g Z o Z-O 311 I
FAX 19CELL I EMAIL -
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