HomeMy WebLinkAboutBLDP-22-005083 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
a'':,„.
CITY YARMOUTH MA DATE 3/14/22 1 PERMIT# BLDP-22-005083
JOBSITE ADDRESS 959 WEST YARMOUTH RD OWNER'S NAME LLOY ANNA M TRS
P OWNER ADDRESS ANNA M LLOY TRUST 959 WEST YARMOUTH RD YARMOUTH PORT,MA 02675 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURFS • FLOORS—› 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/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 1
ROOF DRAIN
SHOWER STALL 1
•
SERVICE/MOP SINK
TOILET 1
URINAL
-
WASHING MACHINE CONNECTION 1
WATER HEATER
WATER PIPING -
OTHER
OTHER DESCRIPTION:drilled out existing cast-iron wye in basement and used SV gasket to replace with PVC to
new second floor stack
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0
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 Ialan bishop I LICENSE 311513 SIGNATURE
MP El JP ❑ CORPORATION ❑# PARTNERSHIP El# LLC El#
COMPANY NAME la.w.bishop plumbing and heating LLC I ADDRESS 23 denver st
CITY I hyanni I STATE IMA I ZIP 102601 I TEL 17745529777 I
FAX I I CELL 17745529777 1 EMAIL 1
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY
FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE El ❑
FEES$ PERMIT#
PLAN REVIEW NOTES