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Home My WebLink AboutBLDP-23-005880 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK B CITY YARMOUTH MA DATE 4/24/23 PERMIT# BLDP-23-005880 '�c Ij ffi=CF JOBSITE ADDRESS 61 BAYBERRY RD OWNER'S NAME Steve Hetzel • P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑v PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES { FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 2 ROOF DRAIN SHOWER STALL 1 1 SERVICE/MOP SINK TOILET 2 2 URINAL _WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING 1 OTHER 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. PLUMBERS NAME (Steve Gilmore LICENSEI13699 SIGNATURE MP DI JP 0 I CORPORATION ❑# I I PARTNERSHIP ❑# l I LLC ❑# COMPANY NAME I ADDRESS I CITY STATE I I ZIP I TEL I L FAX I I CELL EMAIL Ipleasantbayplumbing@comcast.net MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1= CITY 4Ja i_S ./ r -:C �`'� MA DATE -di 2l2. PERMIT# Z. 5 y j o, JOBSITE ADDRESS 4,O SA�� v _oy 2 C� OWNER'S NAME \`hr<'\ '�'i ,- -j E,.\r_ POWNER ADDRESS 1 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEWS RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES E . NO❑ FIXTURES T FLOOR--+ BSM 1 2 3 4 5 6 7 8 ' 9 10 11 12 13 14 BATHTUB I. j CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM • DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER L • DRINKING FOUNTAIN — FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) E '- KITCHEN SINK .. E LAVATORY ROOF DRAIN l' xi'�t'( 1 6- 3 SHOWER STALL 1 I ? i'r k" SERVICE/MOP SINK x C3l ILDINa a rv,tw TOILET 4.44 t 4114 . , 3v ti _ . URINAL �� . WASHING MACHINE CONNECTION f WATER HEATER ALL TYPES WATER PIPING OTHER U.X.-.A.- -I,�yt'v v��\icy. - _ r yy IN J URANCE COVERAGE: I have a current liability insurance policy or it su starti quivalent 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 POLICY OTHER TYPE OF INDEMNITY ❑ BOND 0 OWNER'S INSU NCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mas c neral Laws,and that my signature on this permit application waives this requirement. �� CHECK ONE ONLY: OWNER ❑ AGENT [1] SIGNATURE OF OWNER OR AGENT �I I hereby certify that all of the details and information I have submitted or entered regarding this applicati 1�a,e--an "curat Ito the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will r in c ianc ith al ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • S & y` � < < PLUMBER'SNAME -s.- ��;2_( - LICENSE#�� 1 ATURE MP tg.. JP❑ CORPORATION fil.#�: •w ' PARTNERSHIP❑.# LLLC�,❑# COMPANY NAME 4-kf sk"4`&` \a t r•,-- - 4-ADDRESS r f I �'� � �S s4C�-5 'N- CITY Ic.. ‘['-(� C` -�.� STATE VAek C ZIP 1hI TEL __ - y. FAX CELL //'-I"'f /%-Lls- T EMAIL 06/4scfkl-AML‘.?..--LVA.-QN Cw-tCth a3U - C1(. LI3r0-7