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HomeMy WebLinkAboutBLDP-22-004359 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ik,,.sr, CITY YARMOUTH MA DATE 2/7/22 PERMIT# BLDP 22 004359 t' JOBSITE ADDRESS 7 OUT OF BOUNDS DR OWNER'S NAME REYNOLDS THOMAS E P OWNER ADDRESS REYNOLDS GRACE M 7 OUT OF BOUNDS DR SOUTH YARMOUTH,MA TEL 02664-2040 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY El BOND El 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 Moses Joachim LICENSE 16677 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MOSES PLG&HEATING ADDRESS 301 Buck Island Road CITY West Yarmouth STATE Ma ZIP 02673 TEL 7742511282 FAX CELL EMAIL mosesjoa1974©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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -it" __ CITY e,--psZ7 1M/''Ai oi& MA DATE 62/D / 92 PERMIT# JOBSITE ADDRESS -, C74. Q7I'7�lG/ 7) OWNER'S NAME S AA i1 t.•-Q ,�0 oak" POWNER ADDRESS Ci�/1 cr 73c- 11,4 TEL ! ;I 7"-6 q 4z V''5 33 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:U4 REPLACEMENT:❑ . PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ' , DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ' KITCHEN SINK LAVATORYV F C F I V E 6 ROOF DRAIN 4--SHOWER STALL • . V SERVICE/MOP SINK FRB U 2frit I ` TOILET URINAL _ EUILDt`1G DEPARTMENT . j WASHING MACHINE CONNECTION --- WATER HEATER ALL TYPES WATER PIPING OTHER _ _ I T - - 1 INSURANCE COVERAGE: �/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IV NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 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. `•, CHECK ONE ONLY: OWNER ❑ AGENT El 1� Z SIGNATURE OF OWNER OR AGENT I I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accufate 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 1 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Moses 3 Liu' LICENSE# 160 . SIGNATURE MP a JP❑ CORPORATION❑# PARTNERSHIP Ell LLC❑# COMPANY NAME Nt ^ wr ",i%vtq ke . ADDRESS 30 I tG k_ TSizz,...i I R-4' . CITY LI)21-I VP-km c"Zt/i STATE MA ZIP O Z4 3 TEL 9 e 257�/2 FAX CELL`97'Y 9 I I Z 0 Z EMAIL 4it2k. i c�! �T"d o-iii r r CVOTIFb A Lep H 0 0 H U W Fw z o❑ z • �❑ z O F- rn rn • w O a [. ¢ 0-4 O Q • w O w Cl) �] O o a< • U 1 a_ n_ Lt! = w F- u_ 4.1 0 z 0 H U :=2 a., z z 0 x