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Home My WebLink AboutBLDP-22-005580 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yr, CITY YARMOUTH MA DATE 4/1/22 PERMIT# BLDP-22-005580 JOBSITE ADDRESS 149 STATION AVE OWNER'S NAME Jessica croker P OWNER ADDRESS 149 STATION AVE SOUTH YARMOUTH,MA 02664-0892 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS • FLOORS—a 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 1 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❑ 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 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 Richard Olsen LICENSE 10335 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD P OLSEN ADDRESS PO BOX 2026 CITY DENNIS STATE MA ZIP 026385026 TEL FAX CELL EMAIL office@olsenplumbing.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 -��.1�,i) CITY__. r MA DATE4/511202Z PERMIT # JOBSITE ADDRESS ci n OWNER'S NAME" CSS i Cc' CIO Ler____ 1 P f, OWNER ADDRESS J TEL FAX L I TYPE OR OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL El RESIDENTI PRINT �l PLANS SUBMITTED: YES NOT CLEARLY NEW: RENOVATION: ,� REPLACEMENT: FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - ,r___ _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM -' DEDICATED GASIOIUSAND SYSTEM - .,.. ........_:,may}l DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM `` ._., DEDICATED WATER RECYCLE SYSTEM DISHWASHER - .._. . . DRINKING FOUNTAIN - �i FOOD DISPOSER _.__ ....._- _ FLOOR /AREA DRAIN _ INTERCEPTOR (INTERIOR) ii 1r"--. KITCHEN SINK LAVATORY I . _ _ ROOF DRAIN I _...._ SHOWER STALL i r: ___ ._ SERVICE / MOP SINK LTT _. - . TOILETitf- D URINAL WASHING MACHINE CONNECTION _-_- _-- 3s.:.wn.... ..,....M..... _ 1. WATER HEATER ALL TYPES -�--- 1 s� " pr WATER PIPING }= ■ OTHER _._: _:.___ __ - i - �` NT DE . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES v NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY BOND l OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b Cha ter 142 of th Massachusetts General Laws, and that my signature on this permit application waives this requirement. y P e SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER L� AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc fe the and that all plumbing work and installations performed under the permit issued for this application will be in co c �s6 f my knowledge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I"rC • t'ovisio he PLUMBER'S NAME Richard Olsen �'"✓ ,/. LICENSE # M10335 = ATURE MP v JP J CORPORATION # 2166 PARTNERSHIP - #,_- - & - jLLc # i COMPANY NAME Olsen Plumbing Heating I ADDRESS ; P.O. Box 2026. 357 Hokum Rock Road CITY 1 Dennis STATE MA i ZIP 02638 I TEL 508.385-5290 FAX 508-385-6963 CELL! t G O EMAIL [ocLIIi U in IN o