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Home My WebLink AboutBLDP-22-001856 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/4/21 PERMIT# BLDP-22-001856 tl JOBSITE ADDRESS 73 SILVER LEAF LN OWNER'S NAME BRADBURY DAVID W P OWNER ADDRESS BRADBURY PATRICIA 5 DEVONSHIRE DR CANTON,MA 02021 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES Z FLOORS--* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 1 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 1 LAVATORY 3 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK 1 TOILET 2 1 URINAL WASHING 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❑ 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. 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 William Eastman LICENSE 32766 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME William W Eastman ADDRESS 36 Sun Hill Rd CITY West Barnstable STATE MA ZIP 026681534 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 111 FEES$ PERMIT# PLAN REVIEW NOTES vRECEIVED • $./qa. M OCT L12oz1± . " :iI COI NG,DEPM EISAQHU ETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK t .z' -_' CITY/TOWN y��r1 141 MA DATE cl r I 1_2--I PERMIT# 2-2 ( ,'-``" 3 ` "\ �C' f t� OWNER'S NAME JOBSITE ADDRESS 7 __ OWNER ADDRESS _ , ` TEL . . FAX • TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT PLANS SUBMITTED: YES❑ NO❑ CLEARLY NEW:Ix RENOVATION:❑ REPLACEMENT:CI . - FIXTURES.1 FLOOR-, BSM 1 2 3 4 . 5 - 6 7 . 8 9 1D -11 12 13 14 BATHTUB 1 I - CROSS CONNECTION DEVICE • . DEDICATED SPECIAL WASTE SYSTEM - DEDICATED GAS/OIL/SAND SYSTEM , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM - DEDICATED WA)ER RECYCLE SYSTEM. •- . DISHWASHER I DRINKING FOUNTAIN _ FOOD DISPOSER - FLOOR I AREA DRAIN _ • , _ - - . INTERCEPTOR(INTERIOR) I *KITCHEN SINK • LAVATORY - 3 L , ROOF DRAIN • - - • SHOWER STALL • . / - • .SERV10EI MOP SINK TOILET • a URINAL - • WASHING MACHINE CONNECTION I - _WATER HEA l Ek ALL TYPES I • - - WATER PIPING - OTHER • • INSURANCE COVERAGE: • I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESP NO 0 . • IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POUGY.0 OTHER TYPE OF INDEMNfTY ID - BOND-0 OWNER'S INSURANCE WAVER: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 compliance with all P ,r ent provision of the • Massachusetts State Plumbing Code and 142 of the Genera Laws" / L f" - �° .- V"V • PLUMBER'S NAME �'1Cn'N� l—"'>rS 0/WA._ _ LICENSE# 3 L7 , SIGNA IRE MP Cl JP 1: CORPORATION❑# PARTNERSHIP❑# C # . COMPANY NAME t 6 i(Cary '1 41 U cv 2,3 ADDRESS 3 5Lio 1b ( CITY W C3D4 � STATE(VV.\ ZIP U z 6 TEL - zo5" S EMAIL A ' -1 Q cam ad--, N: FAX • CELL�.� I I