Loading...
HomeMy WebLinkAboutBLDP-23-001911 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK et CITY YARMOUTH MA DATE 10/11/22 PERMIT# BLDP-23-001911 JOBSITE ADDRESS 60 BROADWAY UNIT 12 OWNERS NAME THE TIME SHARE ESTATE TRUST P OWNER ADDRESS 1 ARDELL RD BRONXVILLE,NY 10708 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 - 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 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. 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 Michael Mcbride LICENSE 179681 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I ir4I VCIE % rc\ , ,1Nt1 MA DATE i - PERMIT# 13— 1111 OCT Q 20nBS DDRESS 6 O rQ Az�,1,i-`� OWNER'S NAME'a 0 p OWN R DRESS e/\ G CON d TEL I B' ILD , DEPARTMENT FAX 5 - a•.. =•-- ! - _A CY TYPE COMMERCIAL PRINT 1:: EDUCATIONAL ElRESIDENTIAL CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[ , PLANS SUBMITTED: YES❑ NO k" FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 B' 9 10 11 12 13 14 BATHTUB f CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER / DRINKING FOUNTAIN • FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) _ i KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET I 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 RI, NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY Or 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 i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT ElSIGNATURE OF OWNER OR AGENT L1.1 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 ode.,and C pter 14 f the General Laws. PLUMBER'S NAME A ('i 726/ LICENSE#/767/ SIGNA R MP❑ JP y CO RATI N❑# PARTNERSHIP❑.# Pran-LLC El# COMPAN AME Al cf6 ;Egi r DDRESS e CITY g 4 4/ 5 STATE frrZIP t, Z (Y et./. TEL Q FAX CELL EMAIL • i