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Home My WebLink AboutBLDP-23-002901 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w CITY YARMOUTH MA DATE 11/28/22 PERMIT# BLDP-23-002901 3tl JOBSITE ADDRESS 108 STUDLEY RD OWNER'S NAME RODOALPH BRIAN W TR P OWNER ADDRESS DEL-REE REALTY TRUST 7 FIELD ISLAND POINT SANDWICH,MA 02563-2769 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—, 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/OILJSAND 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 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ 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 Dennis Gagne LICENSE 9804 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DENNIS M GAGNE ADDRESS 31 Cherrywood Ln CITY Marstons Mills STATE MA ZIP 026481761 TEL FAX CELL EMAIL gagnedmg51@aol.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =�atr r CITY '� ,"\,?,o ,', �l MA DATE \ l - -2-3 2-2- PERMIT# 2-5� 2-1 c) I JOBSITEADDRESS [ U$ *Ss.-1 A J (ZCA OWNER'S NAME "Z \G /\ R c Dordk P A-ei;iasc Ke�(t)-7-!zk s r OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL®— PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:Q' 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 l _7.-- , 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) r , I � r KITCHEN SINK r LAVATORY ROOF DRAIN SHOWER STALL F F E V E Q SERVICE!MOP SINK 7 _ TOILET N� 22 URINAL r . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 B ILDlN ' uE RTM-Nl WATER PIPING j OTHER it INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES g:1' NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY 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 i Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ r 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 LICENSE# m 1\ 2oI.:A SIGNA11'E MP 2 JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME (_-0..(5 \k ?`-ham ADDRESS 3I .J2-iiLi-0c0 CA.A_A CITY w\o,R.s Le.A l IN\t( STATE Y}-\_C. ZIP " -7-6"t Z TEL FAX CELL ') )`I- �6"i: ?,N EMAIL 6-6,c9,1.-e0{XL6-_ I e 6�6L (rio 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