HomeMy WebLinkAboutBLDP-21-007004 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=_ t CITY YARMOUTH MA DATE 6/3/21 PERMIT# BLDP-21-007004
II JOBSITE ADDRESS 243 OLD MAIN ST 1 OWNERS NAME[MCNAMARA KEVIN M
P OWNER ADDRESS MCNAMARA MARGARET R 243 OLD MAIN STREET SOUTH YARMOUTH,MA TEL
02664
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑
PRINT
CLEARLY NEW:0 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 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
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1
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 0 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 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 rndrew levesque LICENSE Mlassachusetts SIGNATURE
MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# J LLC ❑#
COMPANY NAME harwich port heating and cooling ADDRESS 461 LOWER COUNTY ROAD
CITY Harwich Port STATE MA ZIP 02646 TEL 5084323959
FAX CELL EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE PERMIT ❑
FEES$ PERMIT#
PLAN REVIEW NOTES