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Home My WebLink AboutBLDP-22-003600 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Q,r71 CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLDP-22-003600 JOBSITE ADDRESS 938 ROUTE 6A OWNER'S NAME Dale Ormon P OWNER ADDRESS 938 MAIN ST YARMOUTH PORT,MA 02675-2172 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 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 1 1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 1 INTERCEPTOR(INTERIOR) KITCHEN SINK 3 LAVATORY 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK 1 TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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❑ 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 Kevin Mccullough LICENS 30511 SIGNATURE MP 0 JP El CORPORATION ❑# I I PARTNERSHIP ❑# COMPANY NAME KEVIN M MCCULLOUGH ADDRESS 91 GOVERNOR BRADFORD RD CITY BREWSTER STATE MA ZIP 026312805 TEL FAX CELL EMAIL 4. 1c — $ < _-1.4_ )\,?... - — ak MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I,EfIt—,-----; mlitf CITY 1'\.‘."1i1/4—,\.LJA'< MA DATE, 1. :-. 1`Jk.. PERMIT# JOBSITE ADDRESS .,q3 ,t.,,.0 I R OWNER'S NAME dc • yi POWNER ADDRESS 9( l__.1 .,.L.v .. _ TEL `i -t ' IFAX! TYPE OR OCCUPANCY TYPE COMMERCIAL ►t. EDUCATIONAL Q RESIDENTIAL E] PRINT CLEARLY NEW:j] RENOVATION:EI REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOO FIXTURES 7. FLOOR--* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB il III CROSS CONNECTION DEVICE ,-y.,- ,-..�„a�," .a., _ ., .mom ...' E, _' -.... ,,. a,. DEDICATED SPECIAL WASTE SYSTEM 1 1L� JJ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ;"," DEDICATED GRAY WATER SYSTEM j a Ij 4 JL DEDICATED WATER RECYCLE SYSTEM L—_ DISHWASHER DRINKING FOUNTAIN .... FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY . . � ROOF DRAIN SHOWER STALL SERVICE/MOP SINK k i` I TOILET I ‘ I I t URINAL . .t I_.. WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES WATER PIPING 1 I I' I a OTHER11111 i I , I_ w ��_ [ a if._ 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IE NO El 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 rec(uirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: 0 ER 0 AGENT 0 I hereby certify that all of the details and information I have submitted or entered regarding this application are true andaC to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli a with a ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. . PLUMBER'S NAME ' L 'v`1A..C.,...t ' - LICENSE# 30 `I t ` SIGNATURE MP JP I-RZ CORPORATION. # ' ' D, PARTNERSHIP LC # COMPANY NAME C ,\Iac ' \o,v,,A ,,,•-vti,,4-1 ADDRESS l c j CSlit C 'J '... _ .. STATE ;,�L ZIP I .4, .5�. j TEL r FAX 1 .p , f � Cl c .. CELIi EMAIL tL\CL \�iiLs 6J�h. l+ _C �L�c, iS�� . �lL B UILf ,K T