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HomeMy WebLinkAboutBLDP-22-005185 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘• --! CITY YARMOUTH MA DATE 3/17/22 PERMIT# BLDP-22-005185 i T JOBSITE ADDRESS 7 SPARROW WAY OWNER'S NAME MULLANE JAMES T P OWNER ADDRESS 7 SPARROW WAY SOUTH YARMOUTH,MA 02664-1654 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL❑ PRINT CLEARLY NEW:0 RENOVATION:0 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 URINAL WASHING MACHINE CONNECTION 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 0 OTHER TYPE OF INDEMNITY 0 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 Robert Judson LICENSEI18399 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ROBERT J JUDSON ADDRESS 34 SCHOOL ST CITY MERRIMAC STATE MA ZIP 018601938 TEL FAX CELL 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK f k;x-;:fi _ CITY IS. Yarmouth MA DATE 03/08/2022 PERMIT # 2Z- JOBSITE ADDRESS 7 Sparrow Way OWNER'S NAME James Mullane i POWNER ADDRESS TEL 508-398-8989 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: L. REPLACEMENT: PLANS SUBMITTED: YES NO❑ FIXTURES -1 FLOOR—i BSM 1 2 3 J 4 5 6 7 8 9 10 11 12 13 14 BATHTUB L T - . --r - 1 it ' - I ......i CROSS CONNECTION DEVICE r-- [ ____ DEDICATED SPECIAL WASTE SYSTEM -, r IT.- - ,E DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM La lt-- ,___. ` 1L . L fr--- r t_____, . ;::::: DEDICATED WATER RECYCLE SYSTEM DISHWASHER -1` F {— LL DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN _ INTERCEPTOR (INTERIOR) r 1! II KITCHEN SINK _._JL-__ - LAVATORY IL, __ ROOF DRAIN __A r SHOWER STALL _ _ I; _ — it_ --- SERVICE / MOP SINK r! TOILET URINAL - 6-7.1, _IL T WASHING MACHINE CONNECTIONJ_ ; .....L. ,. , WATER HEATER ALL TYPES 1 .,H ..„_______ _ IL 1 WATER PIPING r �,�. r _____ OTHER F _ , 4._. 4 I- = .,_l r . - r. INSURANCE COVERAGE: I have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES v NO l_j IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. CHECK ONE ONLY: OWNER AGENT 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 comp) a with all Pertinent pr ' - n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �-- PLUMBER'S NAME Robert Judson LICENSE # 16399 j SIGNATURE MP JP L CORPORATION #L4115 PARTNERSHIPS# LLC0# I COMPANY NAME DiPietro Heating and Cooling J ADDRESS I32 Middlesex Street I CITY [Bradford 'STATE MAJ ZIP 101835 TEL °978-372-4111 I. FAX 1978-241-7325 I CELL I78-914-3131 EMAIL tdeannas@callrevise.com