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Home My WebLink AboutBLDP-23-002041 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . CITY YARMOUTH• MA DATE 10/17/22 PERMIT# BLDP-23-002041 ' I. JOBSITE ADDRESS 56 MELVILLE RD OWNERS NAME EATON JAMES G JR • P OWNER ADDRESS RUSSO COREY L 56 MELVILLE ROAD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 9 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—, RSM 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 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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 0 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 Loder J LICENS0O016 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM B LODER ADDRESS PO BOX 201 CITY SOUTH ORLEANS STATE MA ZIP 026620201 TEL FAX CELL EMAIL BENLODER@verizon.net • y 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY S: 2 tM OLL j 4- MA DATE ' 1 -[ 26 L- _ PERMIT# "Li( JOBSITE ADDRESS 5(Q ► -eCV/l, -C 1Z,T7 OWNER'S NAME, I V� eS '>i TG►C� OWNER ADDRESS 51a vu P 1 L/t AA TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL CY PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-+ 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/01USAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM t DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) , KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL R F. t t E C) SERVICE/MOP SINK _ TOILET f 1224322 URINAL OCTL•1 WASHING MACHINE CONNECTION L__ __ WATER HEATER ALL TYPES BUILD NG D_rAR -MENT WATER PIPING 1 _ OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 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 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. Yid 'AVi .,6 CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE F 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 p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I-A A PLUMBER'S NAME LICENSE# 2 dQ vca IGNAATUR MP 0 JP( 1 . 1 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME uvl1(d."-44 l_ D¢i ADDRESS pc, 201 CITY,Si1-t 0'2.:Lt?4(,F5 STATE LPAr/j ZIP 4z(0{r22 TEL c/ ; " -267S= 7C)e0 FAX CELLS -EP�37 ` 3?,3 7 EMAIL .1 v. Li [�e rr t cc(+c ; (.0