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Home My WebLink AboutBLDP-23-000534 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY !YARMOUTH I MA DATE 18/2/22 I PERMIT# BLDP-23-000534 JOBSITE ADDRESS 172 ROUTE 6A I irss OWNER'S NAME(REAM ROBERT C P OWNER ADDRESS (REAM DEBORAH L 72 MAIN ST YARMOUTH PORT,MA 02675-1708 I TEL ( TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:ElREPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES 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 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 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 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 !Christopher Keith I LICENSE'V690 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# C PARTNERSHIP ❑# LLC ❑# COMPANY NAME KEITH BROTHERS PLUMBING, ADDRESS 19 Milford Street CITY Plymouth �' ZIP 02360 TEL 5083178577 FAX CELL EMAIL stevie@keithbros.com S310N M3IA3?J NVld #11W213d $S333 3H1 SV 3013S N011V0llddtl SIH1 o� saA SAWNNO11,33dSNI 7V T AINO 3Sf1 3313dO 2IO3 MO'I3fl S31 OU hOI L73dSP I JIIISN 11d HJ1O2I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 "_,, kI CITY Yarmouth MA DATE 08/02/2022 PERMIT# 2 3'" c's 3`/ JOBSITE ADDRESS 72 MA-6q,Yarmouth, MA 02675 OWNER'S NAME- di Mcllott te6 ?ea.M OWNER ADDRESS t 72 MA-6A,Yarmouth, MA 02675 P TEL 508 694 5618 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL U RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: i REPLACEMENT: PLANS SUBMITTED: YES ED NO L FIXTURES 1 FLOOR-- 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 - _ URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES - : ''. .L_ WATER PIPING _._ I OTHER 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 i 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 ar true nd curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in Massachusetts State Plumbing Code and Chapter 142 of the General Laws. man with III Pertinent provision of the PLUMBER'S NAME!Christopher M. Keith 1 LICENSE# 16690-M-PL 1SIGNATURE MP i JP CORPORATION'# 4391 PARTNERSHIP # ' -� LLC # 1 COMPANY NAME Keith Brothers Plumbing,9 t __,�rr _ ADDRESS 12 Cedarhill Park Drive, Unit 3 CITY Plymouth STATE MA ZIP 02360 . a FAX TEL 508-317-8577 CELL.508 317-8577 EMAIL stevie@keithbrothersplumbing.com C V 11S ct • • arrit • 1