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Home My WebLink AboutBLDP-23-002489 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •_y,._ CITY YARMOUTH MA DATE 1117/22 PERMIT# BLDP-23-002489. JOBSITE ADDRESS 80 FREEMAN RD OWNERS NAME[John Hobin P OWNER ADDRESS 80 FREEMAN RD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—. RPM 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 1 DRINKING FOUNTAIN FOOD DISPOSER • FLOOR/AREA DRAIN • INTERCEPTOR(INTERIOR) • KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:ice maker INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Joshua Brunelle LICENSE 12314 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSHUA A BRUNELLE ADDRESS 69 GOVERNOR BRADFORD RD CITY BREWSTER STATE MA ZIP 026312805 TEL FAX CELL EMAIL brunelle9806@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 7L n( _ NI-AiSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �' u i 1 /-z -t--- PERMIT #CITYO Ng � �p MA DATE t': 1 �LJB�IT ACURESS KO tkc�G 4tG..�. OWNER'S NAME j� 4-h , L Lr BUlL D G OEM' NI �TDDRESS TEL -777 c�' O vir147, By: TYPE OR OCCUPANCY TYPE COMMERCIAL _ EDUCATIONAL ri RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES -1 FLOOR-4 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK I LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ice, wta,ke,C I _ 5s+i1'4ated tia Lie 6f Ltioiic INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES V NO n IF YOU CHECKED YES, PLEASE INDICATE TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY n 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 the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c lance with all e ' e 'elan of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �oS k. 1c\1' -t (f-C____ .LICENSE # J 3 23/W SIGNATURE MP n JP CORPORATION # _ PARTNERSHIP # LLC # COMPANY NAME AOS cvnc A Flom k ADDRESS /C9 ç:1 ,JJ. çj IJ,.. CITY 13 c"G z'' _ STATE l4t-4 ZIP 6 ZC31 TEL 7797zzcdz7' EMAIL !� �. -0cP CT" r,! . G o r.+ -FAX � ��-CELL -- • . 1.;..,:^•;. F .* L COS i SUN - J • • • • • • r�• N J _c J