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HomeMy WebLinkAboutBLDP-23-002712 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/15/22 PERMIT# BLDP-23-002712 JOBSITE ADDRESS 21 CHASE GARDEN LN OWNERS NAME HART KEVIN F P OWNER ADDRESS HART CLAIRE M 21 CHASE GARDEN LN YARMOUTH PORT,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL a PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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❑ 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 Michael Mcbride LICENSE'ta9681 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 Atl . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK atilla CITY= (j/i r (Y� -1 wr - -- MA DATE _PERMIT# JOBSITE ADDRESS - - - - Z. 1 �F' _ IN `OWNER'S NAMES P W _ OWNER ADDRESS I �7 _._._ -/ 7 4 TEL r TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ' 1 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:7-_, I PLANS SUBMITTED: YES NO FIXTURES- FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB �- _ _ __ a —� �I CROSS CONNECTION DEVICE "� � �� ��� - � E i E DEDICATED SPECIAL WASTE SYSTEM �' DEDICATED GAS/OIUSAND SYSTEM �` ® .1 • I' F • � � DEDICATED GREASE SYSTEM I _fiti [ I:; DEDICATED GRAY WATER SYSTEM , i' — �� _..-_ _ ii y If - 1-- DEDICATED WATER RECYCLE SYSTEM , 1 1 1 - - n sG �; it i� �. � l it DISHWASHER - wIff ,r- DRINKING FOUNTAIN 1------..-17 t -___(r _ -_ I- f 11 i FOOD DISPOSER ------ I1- -1 1_ __ , y` _ ___ FLOOR/AREA DRAIN 1-- -- _-�_ _ -�._ INTERCEPTOR(INTERIOR) ' _.�_. i - KITCHEN SINK _ -I ;- �_ �� I fie.._._ LAVATORY �I _ p, ROOF DRAIN ., �I I , SHOWER STALL ._ _e_,i -I _..4 n 77 SERVICE/MOP SINK _ - TOILET �_ , ;` 1 __ I URINAL - - v L. �- 17- WASHING MACHINE CONNECTION r �"" I _ _ WATER HEATER ALL TYPES c `� li F_.� a _ WATER PIPING /� , t - OTHER ni 1_ r r- . i _ _i - =._ _ l i I: __ it € �i 9j INSURANCE COVERAGE: I. '� �� I' 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 ii4 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 CHECK ONE ONLY: OWNER , 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 /j LICENSE#/201774-1 � MP l JP PrO v_ NATURE • CORPORATION # �W__ RPARTNERSHIP #� 'LLC # -��-' COMPANY NAME i _ / ___; - f _ ADDRESS STATE. .._.... __}_._�_ _,�.�'„,.. .__r�. _ CITYE _L c __. ZIP I.f j FAX ; • �-,,� T , `CELL; __. EMAIL ; _ �. , .1,-0