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Home My WebLink AboutBLDP-21-006313 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/3/21 PERMIT# BLDP-21-006313 i tt(ft ; JOBSITE ADDRESS 50 RAYMOND AVE OWNER'S NAME SHEA EDMUND C TR P OWNER ADDRESS THE BARBARA M SHEA IRR TRUST 1 PLEASANT ST APT 1B-28 WESTFORD,MA TEL 01886 TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 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 WATER HEATER 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Richard Nagle LICENSE 10756 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD F NAGLE ADDRESS 12 Funn Pond Rd CITY South Dennis STATE MA ZIP 026601906 TEL FAX CELL 5083140406 EMAIL r.fnagle1960@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t't 17, CITY (4(A 00441V MA. DATE if - 2-9 - PERMIT# 111-6P- 11-°° JOBSITE ADDRESS lc\a_t_i intke) A-12e_ OWNERS NAME OWNER ADDRESS*S70,_,LY/ e TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT NEW: D RENOVATION:& REPLACEMENT: 0 PLANS SUBMITTED: YES 0 NO CLEARLY FIXTURES FLOOR- ISSMT 2 3 4 - 5 6 7 8 - 9 10 / 11 12 13 44 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATO GRAY WATER SYS DEDICATED WATER RECYCLE SYS r1 DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR(AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP S'NK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES *WATER PIPING _. OTHER 1 r••••••“•••••••••••••• INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes I7No IF YOU CHECKED YES, PLEASE INDICATE HE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 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. CHECK ONE BOX ONLY: OWNER Ei AGENT 0 Signature of Owner or Owner's Agent I hereby certify that ail 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 un the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Co and Ch pier 142 of the General Laws. PLUMBER NAME R/4- A/015 le-- S:GNATURE LICK /07S--6 MP gr<IP 0 CORPORATION 0# PARTNERSHIP D# LLC 0# —1—) COMPANY NAME. r poni5).05 ADDRESS' L2 CITY :peon STATE!Y?:1 , ZIP,C):41:264) EMAIL /ITU TEL_5.0 Fig- 2 L7 7-- CELL 3 ) -67 4/0 g FAX IONOMMNMMINymilimillopmr— - ••+. an,v......••••••••.v .1e 1 i