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Home My WebLink AboutBLDP-22-002791 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,w,_ CITY YARMOUTH MA DATE 11/15/21 PERMIT# BLDP-22-002791 t JOBSITE ADDRESS 176 SEAVIEW AVE OWNERS NAME Gary Roy P OWNER ADDRESS 176 SEAVIEW AVE SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL m PRINT CLEARLY NEW:❑ RENOVATIONS.❑ REPLACEMENT:0 PLANS SUBMITTED: YES El NO 0 FIXTURFS FLOORS—s RPM 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 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 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❑ 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 la the best of my knowledge and that at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Robert Lalime LICENSE 18701 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑it LLC ❑# COMPANY NAME ROBERT C LALIME ADDRESS 575 Main St CITY Mashpee STATE MA ZIP 026492054 TEL FAX I CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • //D.CJ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -(-;_5-;' , D (7Z66MA DATE /' 46 Q2`PERMIT# r JOBSITE AD RESS 176 .$ AWE A V OWNER'S NAME (-A �Z i lZ u� iv 1 2. 221 OWNER ADE RESS _ _ TEL FAX 8 � � I'tiE:'64C"TYPE COMMERCIAL CIEDUCATIONAL ❑ RESIDENTIAL 27--- PRINT-- CLEARLY NEW:❑ RENOVATION:®REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOE ( FIXTURES 1 FLOOR-4 6SM 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 T FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / LAVATORY • ROOF DRAIN ° SHOWER STALL SERVICE I MOP SINK TOILET - URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 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 UABIUTY INSURANCE POUCY Q/ 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 t Massachusetts General Laws,and that my signature on this permit apQlication waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I I hereby certify that all of the details and information I have submitted or entered regarding this application n urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b in compf all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ;,10/-/ 2,0/�jv LICENSE# /37 11 SIGNATURE MP EVriP❑ CORPORATION 0# PARTNERSHIP❑.# LLC COMPANY NAME 4.1YCZ /IA/77,1%x ADDRESS -gr r7Ls— t' 1 , '(f/ CITY il, /QS/ J� STATE 172'4- ZIP TEL 7 TEL FAX CELL ( �� '9pZ c}9 ryEMAIL s / / 441-.J/ G: e--d 00r .S-j am ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# — PLAN REVIEW NOTES —