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Home My WebLink AboutBLDP-23-006029 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, CITY YARMOUTH MA DATE 5/2/23 PERMIT# BLDP-23-006029 JOBSITE ADDRESS 1123 HEATHERWOOD OWNERS NAME DAVIDSON JAMES P P OWNER ADDRESS 1123 HEATHERWOOD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURFS 1 FLOORS—. RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 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❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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 Paul Gorgone LICENSE 20873 SIGNATURE MP ❑ JP CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PAUL R GORGONE ADDRESS PO BOX 1566 11 FROG TREE LANE CITY EAST DENNIS STATE MA ZIP 026411566 TEL FAX CELL EMAIL paulgorgone@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El CI FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •— _c9 CITY ►Q 4A ow MA DATE PERMIT#13C 602i JOBSITE ADDRESS L- 64 G,100 T? OWNERS NAME E5(-1 OWNER ADDRESS l( -zj TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7. 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/OILISAND 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 I LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK I TOILET j URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER I - 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 CO GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY OTH t TYPE OF INDEMNITY 0 BOND ❑ OWNER'S INSURANCE WAIVER:I a ware that th icensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General La , an at my sign re on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT [fi` SIGNAT RE OF 0 R OR AGENT L1.1 I hereby certify that all the de 's and information I have submitted or entered regarding this application are true and accurate to e best of m owledge and that all plumbing installations performed under the permit issued for this application will be in compliance with . -ertinent provis'.n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# 20'73 e.6 - RE MP❑ JP❑ CORPORATION❑# PARTNERSHIP❑.# L//LC❑# COMPANY NAME (2b101(1Q_- e= / - ADDRESS PI/ j CITY !1 L S STATE VOW- ZIP P),0 3 U TEL FAX CELL �� S �Z' /$/' EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT D D FEE: $ PERMIT# PLAN REVIEW NOTES