Loading...
HomeMy WebLinkAboutBLDP-22-005685 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK til=q,R, CITY YARMOUTH MA DATE 4/5/22 PERMIT# BLDP-22-005685 ,a JOBSITE ADDRESS 296 STATION AVE 1 OWNERS NAME DENNIS-YARMOUTH REG SCHOOL P OWNER ADDRESS 210 STATION AVE SOUTH YARMOUTH,MA 02664-3000 TEL 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 ROOF DRAIN SHOWER STALL - SERVICE/MOP SINK TOILET 3 URINAL 1 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 • 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 Troy Gilbert LICENSE25383 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME TROY J GILBERT ADDRESS 39 STATION ST 39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherine@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES 5 PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' -Elgiff MA DATE 04/01/2022 PERMIT# • 2 - CITY Yarmouth 5r�o 8j^ 296 Station Ave S. Yarmouth MA 02664 OWNER'S NAME Dennis Yarmouth I School JOBSITE ADDRESS OWN R Regional OWNER ADDRESS.296 Station Ave S. Yarmouth MA 02664 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Qi EDUCATIONAL n RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:V REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO Ki FIXTURES Z 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 I AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY - ROOF DRAIN _ SHOWER STALL SERVICE I MOP SINK TOILET , 3 URINAL 1 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 ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 47 OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: 1 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 SIGNATURE OF OWNER OR AGENT l 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. � Q/2� PU L MBER'S NAME Troy Gilbert LICENSE # 25383 SII ATURE MP ❑ JP CORPORATION V#4350 PARTNERSHIP El # Lc El# COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY South Yarmouth STATE MA ZIP 026A4 TEL 508-737-8747 FAX CELL 508-850-6955 EMAIL KatherineCa,Coastalphc.com