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Home My WebLink AboutBLDP-21-003026 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • CITY IYARMOUTH MA DATE 111127120 I PERMIT# BLDP 21-003026 1 E_ JOBSITE ADDRESS 126 SILVER LEAF LN I OWNER'S NAME(BURNS BRIAN M P OWNER ADDRESS (BURNS CYNTHIA A 475 CHAUNCEY WALKER RD BELCHERTOWN,MA 01007 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL al PRINT RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES NO El CLEARLY NEW: 0 FIXTURES _1 FLOORS BSM 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I 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: YES❑ NO ElI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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. %9 L1 PLUMBER'S NAME (Denis Gagne LICENS41113239 I SIGNATURE MP ® JP ElCORPORATION ❑# I I PARTNERSHIP El# I I LLC 0# I I I COMPANY NAME IDENIS J GAGNE I ADDRESS 111 Camp St CITY West Yarmouth I STATE (Ma I ZIP 102673 I TEL I I I I FAX 1 I CELL 17748360784 1 EMAIL 1 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Ok g.714/z02c5. Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT it PLAN REVIEW NOTES MRP .• Pfig e 6'C ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �' PERMIT#. -� -OQ3 Da) -'ter_- CITY CAR rmo�„ _. �. _-71 MA DATE _I l:` U-_. ____ ~-� JOBSITE ADDRESS , ILUt te_ 1..?.a- ./A-n,f, _ -- JOWNER'S NAME l t YY� + lC1'�- POWNER ADDRESS L i TEL 5� - 73 7 "L FAX ________jTYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL -I RESIDENTIAL PRINT PLANS SUBMITTED: YES ® NO® CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: li _FIXTURES -1FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB (__L-=_JL 1 L �...J=11__:...-.�._, 1._..._ _ 1�.�,_1�..___ _I _I _- _1 ,..�_-- a�r..,y. CROSS CONNECTION DEVICE I. LY�-J -a-� DEDICATED SPECIAL WASTE SYSTEM I .,., x4�._.I _ ,_- -_ .�____ .� r_� DEDICATED GAS/OIUSAND SYSTEM I. i� J( _v_-_.._.I,)+....___j _-jr-7-11 - -____•.:.-. •,-�.� '--- - �.�L- -k L �1�4- _._ . .._� DEDICATED GREASE SYSTEM I� _w !____..3.�.._-.._I - ..-- ,J__ ,,��.--�,1,�-. _r-_,ii.__� i-_.:1 • . .. I DEDICATED GRAY WATER SYSTEM . #i . . — � - __� I _�r I �I --. _i_ x . �.-�--�.� -�j -- -�` DEDICATED WATER RECYCLE SYSTEM I,-__ i .- . L 7 1 lJ1____.__ lb_ '�- -_ 1 L- -�- z i _ )1 , _ j DISHWASHER :�L L_ .s..--:.. ti._ 'i '_ :_ _. li -. ;I____ L. ..._. :....i -_; DRINKING FOUNTAIN M - -FOOD DISPOSER ' ;1 e z_ 1..__ . _ ,-d1-_.J - �.�.� FLOOR / AREA DRAIN M . .1 JAI :' - ' � _ -�1 = INTERCEPTOR (INTERIOR) I ,- Ir- i( Irt-i__J--,. ._ ____ Lj.E.i_.. .,.. _ii ___. I__ ,1_,: . ! - _ KITCHEN SINK _1 ' I-67__ •,, •� t! _ .. �I �..�,___LAVATORY I�_ !_ �_�J 1 —�.�._. ___ F. ---.i 1_.._ �1 L ! .s.., _11- .II . I ROOF DRAIN � _ I ^�i..-..,�......�(- �� I � SHOWER STALL 1. '__ ,,._ :.�i.�_ 'i__ . 1 I __.. _:I .r..j I____ 1 . L -�J a.:_.0 . -mot -- ._.. _-_' .....,L L��_ IL. .�'14...., ?L 11 1!_ ..-11l r, 1.,_r.� L...—i{;J f -� f._ SERVICE / MOP SINK _. }- TOILET ! ,__- ._�. . _i _. .�.# _ i. . . 'i - JI _..� k._. L._.x _ ` --r___L„ ,.�.w. r 3i URINAL i� _ _ `- I_____,,1 __-3 i ` _ __ .__ _.......1 ji.___ i , ._AL,..___1 . 'L®..,_9 _ , � = I i I _ _ - �I �� 1�_.�. WASHING MACHINE CONNECTION _.. ,�,,.. .�,�.,.�:1t«, L-a....£._- 1. -.�...,1 1_..„- �-1.-�� _._ s -, WATER HEATER ALL TYPES "=x _..:.�=.Lowx�., � :.��.�._ :i r . - ' ' 1 �:11 1-- ._ j i j ....,mac �a .,...�....�-..__._:1 l.e v--r 1 i L_..--- WATER PIPING IH q_- .-I, i� —al ��.�.� 1.��.a _� �. L. OTHER !�_�. L.�r - .II_� II._ 11 ._� 1 I - _11-— - -.�-.1I__ I.... .-_1(- �_ — # 1 .�.�.�C'^s.� -�TY�-`^-`�Ill` "'��.. I L � 11 - _ 7 I _ �� - — I--" ' _ _-7-- r-76_-- .,-••-`•'•-r•--. -'‘- -a- -c•----.1 =-- - . 11 - --(--- • -f. - I . J----- .1WWWWW--- INSURANCE COVERA : I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG! Cis I . YES (, NO LIA IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ,� 1/2.\c„,k1, LIABILITY INSURANCE POLICY � OTHE R 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 El 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �9 i ,e,..... A . • PLUMBER'S NAME [ u �A .tA i‘ M=- 114\4- - 1 LICENSE # 1 1/14804 j SIGNAT .t.- • MP i. JP 0 CORPORATION XI# 3 2 3a__i PARTNERSHIP rj# ; LC 0# µ ADDRESS 1 C�a. _ _ COMPANY NAME[A 11 fo i,,Ti e n STATE ,__ �. ZIP _0ou13 _,3 TEL 71 -j 3 b- 61 Pi J CITY � w� � FAX 1 ICELLI jEMAlL . . . - 4 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES r Itid j i • a `j •