HomeMy WebLinkAboutBLDP-23-000745 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
T CITY YARMOUTH MA DATE 8/12/22 PERMIT# BLDP-23-000745
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JOBSITE ADDRESS 33 THACHER SHORE RD OWNER'S NAME SWANSEY JOHN D GENERAL
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P OWNER ADDRESS C/O BASLER JAMES&NANCY TRS 42 VESPER LN YARMOUTH PORT,MA J 676 NER TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ED
PRINT
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES • FLOORS BSM, 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 2'
CROSS CONNECTION DEVICE ,
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM -
DEDICATED WATER RECYCLE SYSTE
DISHWASHER 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK 2
_LAVATORY 2 3
ROOF DRAIN _
SHOWER STALL 1 2
SERVICE/MOP SINK 1 ,
TOILET 2 3 ,
_URINAL
ASHING MACHINE CONNECTION 1
WATER HEATER 1
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 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 Kevin Abbey LICENSE 1Q357 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# .l 1 PARTNERSHIP ❑# LLC ❑#
COMPANY NAME Abbey plumbing&heating ADDRESS 596 Queen Anne Road
CITY Harwich STATE MA —1 ZIP 02645 TEL
FAX 5084308462 CELL 5083670437 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT
PLAN REVIEW NOTES