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Home My WebLink AboutBLDP-21-005478 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/23/21 PERMIT# BLDP-21-005478 JOBSITE ADDRESS 964 ROUTE 6A OWNER'S NAME john nash P OWNER ADDRESS 964 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 2 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 El 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 LICENSE 34056 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THEO PLUMBING AND HEATING ADDRESS P.O. Box 397 P.O. Box 397 LLC CITY (Centerville I STATE MA ZIP 02632 TEL FAX I I CELL I I EMAIL theoplumbing@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEESS PERMIT# PLAN REVIEW NOTES b\3n li / mil POnnU5ETT5 UNIFORM APPLICATION ION FOR A PERMIT TO PERFORM PLUMBING WORK -7:,,,,............ 1_-_...:4----7-7-__-? =a10'T t%t. :16 k PAlt __ram CITY MA DATE 7O PERMIT# •JOBSITE ADDRESS 16 iur 44 OWNER'S NAME p OWNER ADDRESS CI(1 (2 6 a- TEL ( i ) 'S _'O FAX TYPE OR OCCUPANCY TYPE COMME CIAL❑ EDUCATIONAL ❑ RESIDENTIAL Lg. PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO FIXTURES Z 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/OIUSAND SYSTEM _ - DEDICATED GREASE SYSTEM _ . DEDICATED GRAY WATER SYSTEM - DEDICATED WATER RECYCLE SYSTEM DISHWASHER . DRINKING FOUNTAIN . FOOD DISPOSER FLOOR/AREA DRAIN _ - INTERCEPTOR(INTERIOR) - KITCHEN SINK1 _ LAVATORY _ - ROOF DRAIN - SHOWER STALL _ - k. SERVICE/MOP SINK TOILET Z - URINAL WASHING MACHINE CONNECTION 1. WATER HEATER ALL TYPES _ - - WATER PIPING - OTHER INSURANCE COVERAGE: its substantial equivalent which meets the requirements of MGL Ch. 142. YES'NO ❑ I have a current liability insurance policy or q q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d 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. CHECK ONE ONLY: OWNER 0 AGENT 0 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. ..------2_______ PLUMBER'S NAME ‘6"0145 "`ci '5 LICENSE# 7`d% - ) SIGNATURE MP JP CORPORATION ❑# PARTNERSHIP❑# LLC IE(# c o s 3444 3 r� h+` �` `^- AfiDDRESS �.v (je> ? Th COMPANY NAME I \v20 V‘`)/ r l / r t,� ZIP 0 Z 6 5 Z.-- TEL 7�g el "'�o 3? G CITY l E'h � �.� \ �- STATE V'`� l< < ( -h_ ' ,J,"--• ( ( oc3.(d'"N-� FAX CELL EMAIL l"'._� � ij,� /