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Home My WebLink AboutBLDP-21-005581 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R CITY YARMOUTH MA DATE 3/29/21 PERMIT# BLDP-21-005581 I lk JOBSITE ADDRESS 17 SNOW BROOK RD OWNER'S NAME JONES EDWARD F JR P OWNER ADDRESS 204 I ST SOUTH BOSTON,MA 02127-4166 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION E REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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❑ 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 Joseph Halloran LICENSE#0984 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSEPH M HALLORAN ADDRESS 29 Forest Glen Rd CITY Hyannis STATE MA ZIP 026012537 TEL FAX CELL EMAIL ^ 4 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT El ❑ FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _. — / S� oP2t-oo SSg/ �v+'= CITY/TOWN /1-- //J M C/� '\ MA DATE .3 2 2 j PERMIT# (3L '�11i,;'a JOBSITE ADDRESS / 5 w OWNER'S NAME 87i) ic/- FI4•'ti�i y OWNER ADDRESS 36 CL/p p b014/0r /i NI�, TEL 67 7-76C6-(7 2 ZFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 111---- PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[v]� 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/OIUSAND 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 / ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET / URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er OTHER TYPE OF INDEMNITY 0 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 ate to then•• knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com nce ' all Pertin t • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /Jrir PLUMBER'S NAME 6"5/t f2)1 N4,/b R/9-./ LICENSE# /U 1&f SIGNA URE MP❑ JP❑ CORPORATION ID# PARTNERSHIP❑# LLC❑# , COMPANY NAME J"S2fll /nI d M^� P1 cif (�i ADDRESS �� 5t GLk N g-a fi CITY 0/4 J M I STATE / l'9 ZIP d L("°/ TEL S d s - '6- $'z4 37 FAX CELL EMAIL S O W�� w eV COAf C 4- At/AT 5 r�i