Loading...
HomeMy WebLinkAboutBLDP-23-003505 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w , CITY 'YARMOUTH I MA DATE 112/27/22 ' PERMIT# BLDP-23-003505 JOBSITE ADDRESS 122 WHITES PATH I OWNER'S NAME'DAVENPORT DEWITT TR P OWNER ADDRESS DAVENPORT REALTY TRUST 20 NORTH MAIN ST SOUTH YARMOUTH,MA TEL ' 02664 I TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES 1 FLOORS-4 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 2 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 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 El 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 informitition 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 'Troy Gilbert I LICENSE'tt3573 SIGNATURE MP 0 JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I I COMPANY NAME 'COASTAL MECHANICAL I ADDRESS 121 L Fruean Ave CITY IWAREHAM I STATE (MA I ZIP 1025711324 I TEL I FAX I I CELL I I EMAIL 'katherine@coastalphc.com IP WNW? MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4. °1 CITY Yarmouth MA DATE 12/22/2022 PERMIT# 2-1 3 So S} =��„`� JOBSITEADDRESS 22 Whites Path OWNER'S NAME 22 Whites Path LLC POWNER ADDRESS 21 L Fruean Ave S. Yarmouth MA 02664 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION:i2r REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7. FLOOR—+ BATHTUB BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 2 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL 21 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current lia_ bi�Iity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW NO ❑ LIABILITY INSURANCE POLICY fcil 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 0 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 Troy J Gilbert LICENSE /4 �de �j # 13573 SIVii ATURE MP`_' JP 0 CORPORATION 0# PARTNERSHIP 0# LLC V# COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY S. Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX CELL EMAIL Katherinena Coastal phc com