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Home My WebLink AboutBLDP-22-002631 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK in CITY YARMOUTH MA DATE 11/9/21 U�' PERMIT# BLDP-22-002631 JOBSITE ADDRESS 2 BARKLEY ST OWNER'S NAME Thomas Barton P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL al PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOORS—I 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 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 ❑ 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 (David Whelan I LICENS413O46 I SIGNATURE MP 0 JP ❑ CORPORATION ❑# I J PARTNERSHIP ❑# I I LLC 0# I COMPANY NAME IDAVID A WHELAN J ADDRESS 152 schooner dr CITY ICOTUIT I STATE IMA I ZIP 1026353423 I TEL I I FAX I I CELL I I EMAIL Idaveawhelan@gmail.com I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =_- CITY/TOWN P)241✓'v 7/L) MA DATE l/bsIZ I PERMIT# 2-Z- t( 3/ JOBSITE ADDRESS 2 6P it-/ALE '7 S OWNER'S NAME MP 117 E # l? a-' OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL EV PRINT �/ CLEARLY NEW:❑ LK RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-, BSM 1 2 I 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 i LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET C URINAL RE IVED WASHING MACHINE CONNECTION :WATER WATER HEATER ALL TYPES NA 0 2021 WATER PIPING __. _ _ OTHER BUILD NG D PARTMENT By: --- - ----- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E ' NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 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 ❑ AGENT ❑ 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 accur to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i m iance wit all Pertin tion proof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i1'P�n i1 f O J fit LICENSE# /3�y G /��' SIGNATURE PLUMBER'S NAME T' MP f1. JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME 19144 )0 N iNr0''' Otvitf,0,/{i'- ADDRESS 5-2- Sio•'+!! CITY L-✓ /err►-1E �^�70 � STATEfl W ZIP O TEL 1l4r-2 7 (1r 23 V FAX CELL EMAIL 9Pve-.477^4/.1 t cA, e ).9/G.e ni Ci 1.49 D