BLDP-22-005442 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 3/29/22 PERMIT# BLDP-22-005442
JOBSITE ADDRESS 233 CRANBERRY LN OWNER'S NAME Neil Thibodeau
P OWNER ADDRESS TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑
PRINT
CLEARLY NEW❑ RENOVATION',0 REPLACEMENT:❑ PLANS SUBMITTED: YES El NO
FIXTURFS FLOORS—. BSM 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
LAVATORY 3
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK 1
TOILET 2
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 0 NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND 0
OWNERS 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 Douglas Langtry LICENSE#1305 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME DOUGLAS P LANGTRY ADDRESS 1268 ROUTE 28 1268 ROUTE 28
CITY S YARMOUTH STATE MA ZIP 026644459 TEL
FAX CELL EMAIL doug-aqua@comcast.net
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
CITY YARMOUTH MA DATE 3/23/2022 PERMIT #
JOBSITE ADDRESS 233 CRANBERRY LANE OWNER'S NAME NEIL THIBODEAU
pOWNER ADDRESS 9 LINDA CIRCLE, SUTTEN, MA 01590 TEL 508-207-8626 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL n RESIDENTIAL 0
PRINT CLEARLY NEW: _ RENOVATION: ❑� REPLACEMENT: ❑ PLANS SUBMITTED: YES 7 NO ❑■
FIXTURES Z FLOOR--• BSM 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 SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR /AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY 3
ROOF DRAIN
SHOWER STALL 1
SERVICE / MOP SINK 1
TOILET 2
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER 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. YES ❑■ NO D
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.
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, he b st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in c p n with all P ine provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t
PLUMBER'S NAME DOUG LANGTRY LICENSE # 11305 GNAT RE
MP . JP ❑ CORPORATION _ # PARTNERSHIP ❑ # LLC # 3081
COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28
CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367
FAX 508-619-3367 CELL EMAIL DOUG-AQUA@COMCAST.NET
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES