HomeMy WebLinkAboutBLDP-23-002500 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
.' CITY YARMOUTH MA DATE 11/7/22 PERMIT# BLDP-23-002500
i' JOBSITE ADDRESS 54 DRIFTWOOD LN OWNERS NAME'MAHONEY EDWARD L
OWNER ADDRESS MAHONEY DIANE M 26 PIER 7 CONSTELLATION WHARF CHARLESTOWN,MA TEL
02129
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES z 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 El 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 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.
PLUMBERS NAME (James Oconnor LICENSE't2989 I SIGNATURE
MP 13 JP ElCORPORATION El# I I PARTNERSHIP El# I I LLC ❑# I
I
COMPANY NAME IJAMES OCONNOR I ADDRESS 1117 GREAT MARSH RD 1-
CITY ICENTERVILLE I STATE IMA I ZIP 1026322413 I TEL I
FAX I I CELL I EMAIL Ijimoconnorpiumbing@gmail.cpom
MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK
7i ��_ _ �'` enew.:`I4 MA DATE 1 I 7 LZ PERMIT#2 3 — 2 Sod
. D SS S 44 I1 r;c+.,o� OWNER'S NAME W!d LIc3�J Ey
NOV 0�'�IZ� •
OWNER D SS ‘ TEL FAX
B DING DEPARTMENT TEL
THY PE COMMERCIAL❑ EDUC TIONAL 0 RESIDENTIAL lr2
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 NO V
FIXTURES-1 FLOOR—+ BSM 1 2 3 4 5 6 7 6' 9 10 11 12 13 14
BATHTUB _
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 T
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR) _
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK
TOILET _ ,
URINAL
WASHING MACHINE CONNECTION
•
WATER HEATER ALL TYPES
WATER PIPING
OTHER ,
INSURANCE COVERAGE:
C I have a current liabilittinsurance 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 POUCY V 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 apQiication waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT 0
Z SIGNATURE OF OWNER OR AGENT
Lk.I 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. i /1 --�
PLUMBER'S NAME LICENSE#1 torsi . C J SIGNATURE
MP Lla JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC�#
COMPANY NAME S till dcor.i,N rt PI m 5 el Ni, ADDRESS 1 11 (7rcc 4 I1 t, P-J
CITY C e.-rte1 , 1Ir STATE 1114 A ZIP 02432. TEL
FAX CEL.L774f 353 R 301—. EMAIL Ave ce,,nncit plvfl\ ► t ta:I . c'CrAl