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Home My WebLink AboutBLDP-22-006229 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/28/22 PERMIT# BLDP-22-006229 JOBSITE ADDRESS 822 ROUTE 28 OWNER'S NAME MACLYN LLC P OWNER ADDRESS 822 ROUTE 28 SOUTH YARMOUTH,MA 02664 -I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 ROOF DRAIN SHOWER STALL _ SERVICE/MOP SINK _ _ TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER , . WATER PIPING 1 OTHER 1 OTHER DESCRIPTION:drain piping 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 0 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 Michael Mcbride LICENSE 119681 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth I STATE IMA ZIP 102673 I TEL FAX I CELL I I EMAIL Istinger.mcbride@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 1 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT 0 PERFORM PLUMBING WORK Mir _, CITI' :V � P n,�0 MA DATE 1/ ZZ_ PERMIT# Z Z - 17 S JOBSITE ADDRESS 22, 7c1/ 7 7/(e-T 2 OWNER'S NAME Ci9/0e( D . 7) 4 POWNER ADDRESS TEL l FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Icer. EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NOn FIXTURES 1. FLOOR-4 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 - 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ---- 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 ALL TYPES �n WATER PIPING OTHER r � /) na ,1- / INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D„ OTHER TYPE OF INDEMNITY 0 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LI,I 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 complian with all Pe •nnnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. { PLUMBER'S NAME LICENSE# SIGNATURE MP❑ JP V CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME fill Cl C Pf—t+- ADDRESS Ll (i�/ CITY /1----17 Cl /-) [ 3 /�A STATE��=- - ZIP ,0 2 (c, 6 / TEL e FAX 7 U �/ 11 Z� CELL EMAIL, 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