HomeMy WebLinkAboutBLDP-22-006805 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 5/24/22 PERMIT# BLDP-22-006805
JOBSITE ADDRESS 7&9 CHAMBERLAIN CT OWNER'S NAME Colleen Allison
P OWNER ADDRESS 7 CHAMBERLAIN CT WEST YARMOUTH,MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑
PRINT
CLEARLY NEW:0 RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El
FIXTURES • 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/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
WATER PIPING 1
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 El 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 William Heath LICENSE W021 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME WILLIAM 0 HEATH ADDRESS 265 GREAT WESTERN RD 45 Main Street
CITY Sandwich STATE MA ZIP 026452428 TEL
FAX CELL EMAIL fbillsboat330@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
3
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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`=. sl=s" CITY ij/14'2»'1/�' 1�+ • MA DATE ri, 7_ / 5 ZozZ PERMIT# L �v
JOBSITE ADDRESS 1:7 C m i.t/z/ii,./ 6'; OWNER'S NAME - 4L r>svA/
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OWNER ADDRESS 1,9 g#2.2r _ ,Qo, /4 v 6+1A S .in r►- . TEL 97i-7y61 id Z2 IFAX
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TYPEOR OCCUPANCY TYPE COMMERCIAL [ EDUCATIONAL P RESIDENTIAL[✓r
PRINT
CLEARLY NEW: RENOVATION:Q REPLACEMENT:11 PLANS SUBMITTED: YES 0 NO 1
FIXTURES 7. FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB '-- ---7 _i I�-- i I
s
CROSS CONNECTION DEVICE _ _- ' _
. I 7 ; _ - __ -DEDICATED SPECIAL WASTE SYSTEM 1 1 ; _ 11 - ► "
DEDICATED GAS/01VSAND SYSTEM � '� d _ � �� i{ _ _ 1 .
-�.. -tea:-y. ._. _ r _ - a
DEDICATED GREASE SYSTEM _ -
}
DEDICATED GRAY WATER SYSTEM a ' 7' . ti I ! , ,
DEDICATED WATER RECYCLE SYSTEM I -': i, i - , ,,,
----=_ -.--- r- - `
DISHWASHER ', f _ k j
DRINKING FOUNTAIN I tR ,_ - 'I ii -4 t, t ! 1
FOOD DISPOSER `,. =
FLOOR 1 AREA DRAIN
INTERCEPTOR(INTERIOR) _! --- ! y !Mir:
KITCHEN SINK r i [ li f
LAVATORY ii - 1 1 T i r 1 �
ROOF DRAIN -- ;- ---- t _r : _ 4; _.,. . ; 5
-1 -= _-- _ f,:__..;,.-ti•- , --- �� - —s _ _ _—.J
SHOWER STALL �._ R- { :
SERVICE I MOP SINK f�'R� - # P ���
TOILET ; �,�, �.A. i _ ^'. a IV'
URINAL �._.� .�_�.:� � = .__—�:. ...:4.�►:_� °—. - --:. -� -:::, - _ _.__ _. ,,���`�"�
WASHING MACHINE CONNECTION ! _,► r- �1-1i R
WATER HEATER ALL TYPES _ j
WATER PIPING _ r w. `{1 '1 I- -,_ 1 ii iLb : 0 !r I
_ ,
1I11L14 iMm
OTHER .�j.1c-I, f<'o t.rasalsmomme
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INSURANCE COVE.1 RAGE: ;
I have a current liablilty insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES f NO ri
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY s OTHER TYPE OF INDEMNITY BOND fl
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 P AGENT 0
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. .�
A___-----
PLUMBER'S NAME I (A: . ( m�. '' /-11: rx� ',3- =LICENSE # W7 /Z-7/ ' SIGNATURE
MP[ ( JP ____; CORPORATIONLJ#L^, !PARTNERSHIP Li LLC •#
COMPANY NAME I +/4 jeotv.�'�, n✓ ADDRESS .y _ ('41,.1.' lT24-a-s -
CITY! �n�0 w c!^A STATE I /ma- ZIP L t'Z TEL SU e--7 76 - /ov S" ;
FAX 1 { CELL I7 y yt 7 jEMAIL 4,//sXf 330 e ,
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