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HomeMy WebLinkAboutBLDP-22-006639 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ye CITY YARMOUTH MA DATE 5/17/22 PERMIT# BLDP-22-006639 JOBSITE ADDRESS 507 NORTH DENNIS RD OWNERS NAME NOVAK MITCHELL S P OWNER ADDRESS CAMPBELL-NOVAK JEANNE 507 N DENNIS RD YARMOUTH PORT,MA TEL 02675-2144 TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL© PRINT CLEARLY NEW:m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO E FIXTURES FIOORS—. RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 . 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 E 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❑ OWNERS 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 William Heath LICENSE 16021 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM 0 HEATH ADDRESS 265 GREAT WESTERN RD 45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat330@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES oiel. Pd MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =c.y 1 CITY �At41-rYi i '1. /4,a.r --- MA DATE I _._ IPERMIT# t l (4' 15 (') JOBSITE ADDRESS I S-�: '7 it,k,2 r1, /2,,,,,,,, ,. i et..4 ,?.4. , OWNER'S NAME 2.4_4-,A„K AL,,./4-k , P i OWNER ADDRESS . TEL1 y f,yy oz,e C FAX TYPE OR OCCUPANCY TYPE COMMERCIAL n EDUCATIONAL n RESIDENTIAL RV PRINT CLEARLY NEW: i✓- RENOVATION: LI REPLACEMENT: ► ' PLANS SUBMITTED: YES , 1 NO-1 FIXTURES 7 FLOOR--, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ;;---iS---- i_-- -- --, -- r---- I ' } _ - -•• -_ - - _ . -- — _ . ___ _ is ._— ! CROSS CONNECTION DEVICE '�^ -, 1 -- --- DEDICATED SPECIAL WASTE SYSTEM I' DEDICATED GASIOIUSAND SYSTEM f -' -I ? I - DEDICATED GREASE SYSTEM , =, ! 1 DEDICATED GRAY WATER SYSTEM i '� �t a 1-- i; � i 1 !I DEDICATED WATER RECYCLE SYSTEM ,i f f, .i , j 'J DISHWASHER a___ , �. s ii ,. :, ii 1 }i DRINKING FOUNTAIN - F f-----777i FOOD DISPOSER i 7 - i 1 -} I , FLOOR/AREA DRAIN __- 1 x_A- - • ' i` ��---^--��++ INTERCEPTOR(INTERIOR) - m�_�- �"- = ti: r r.�..f.� ....�_ ►. , , it , KITCHEN SINK `- - W; _._ LAVATORY '_ 1 ' � �,. � I ROOF DRAIN ro�___. _ _ , SHOWER STALL i __ ,-__'I # i l _ �.`1 i,lig inn SERVICE! MOP SINK TOILET — # --•- - ? — URINAL �<< r J --iil --- ; _ fl _ WASHING MACHINE CONNECTION I ,_ _- ' I, ;j i 1 - - J ,, WATER HEATER ALL TYPES ' - I i WATER PIPING OTHER 3 sclt 'l L (Ai ' 1 - -`---- IIMIIIIIIIIIJIIIIHNIHIIIMMIIIIIIIIIIFIIIMIIIIIIIIIII 'f i _ I I ft . Pill IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIILWIIIIIIIIWNMIMIMMWIFMIMIIIINWIIVBTMMRMIISMIIII INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[VINO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1. 7 OTHER TYPE OF INDEMNITY BOND nj 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 [ _I AGENT n 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. / t C. '4r.' PLUMBER'S NAME i w' " -'i / q _ .;LICENSE# 2 'Z j SIGNATURE MP 07 JP CORPORATION Li#j — ]PARTNERSH(PL]# LLC, -# 1 G _ ' ADDRESS "� �ir1� S- i COMPANY NAME I -'3 f- .S-tn.) I (- - _ :_�:.. .�__._ _ ' ` CITY S:A-Ad,k4 1 c.,L, STATE { ✓vi,4 ZIP 02- Tt TEL _ 3' { 5 7 2 4 l ev i 1 FAX 1 ; CELL 7?yi yY7 ' EMAIL 1 ►';//.3 .�:: ,kr 2. 0_ e 7- 4,1,C.. Con-?. , . 1 - - gi 7 0