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Home My WebLink AboutBLDP-22-006059 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/21/22 PERMIT# BLDP-22-006059 r JOBSITE ADDRESS 3 HERITAGE DR OWNERS NAME DAVIDIAN DAVID B SR TR OWNER ADDRESS THE DAVIDIAN FAMILY TRUST 160 GOULD ST STE 320 NEEDHAM,MA TEL • i 02494-2300 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:0 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 LAVATORY 2 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 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 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 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. 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. PLUMBERS NAME Thomas Bulger LICENSE 10099 SIGNATURE MP El3P El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THOMAS P BULGER ADDRESS 10 PIPER ST CITY IOUINCY STATE MA ZIP 021696428 TEL FAX CELL EMAIL tombulger2@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 /2O O d ----"hl1ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK VAD11 CITY \.l (\`( Yh D J T� MA DATE L. I 11 2 02 2PERMIT# ZZ (00.59 A -'4 2C 2 BE ITE ADDRESS `", �� L V 1 TJ 9 C ) V OWNER'S NAME Lo f'..79 q\\D W C.)&5 B ILDIr JEPAR ADDRESS TEL FAX fay - —-- - -- TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO El FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB t 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 LAVATORY ROOF DRAIN SHOWER STALL I ` SERVICE/MOP SINK TOILET r / i URINAL " . j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING / OTHER INSURANCE COVERAGE: - j I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[71- NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY 11, 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 j Massachusetts General Laws,and that my signature on this permit application waives this requirement. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LL► 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 cotnplia with all Pertinen rovisi f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �"LICENSE PLUMBER'S NAME —�{-k c vv 0�S l # �y� / �� I COCQ 9 SIGNATURE MP ® JP❑ / I CORPORATION Rail u 5 I PARTNERSHIP❑.# LLC❑# COMPANY NAME L��h "1 l I (.J D65-. B C ADDRESS g (.01 V� �-f 3 CITY I N_Lvv, STATE a- ZIP d 5 4O TELL ( 7 -°IDb -9D30 FAX CELL EMAIL k O W[ U l C c\/' c q Q VKI1 r 1�� ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • • • • •