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Home My WebLink AboutBLDP-22-004184 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK (= CITY YARMOUTH MA DATE 1/26/22 PERMIT# BLDP-22-004184 JOBSITE ADDRESS 9 Vernon St OWNER'S NAME MICHELLE GRAVELINE/GRAVELINE 1 RuST P OWNER ADDRESS 9 VERNON ST WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YESD 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 4 ROOF DRAIN _SHOWER STALL 1 2 SERVICE/MOP SINK TOILET 1 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING OTHER 1 OTHER DESCRIPTION: rinse station INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 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 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. 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 Scott Dugas LICENSE 16845 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SCOTT DUGAS PLUMBING INC. ADDRESS 85 Anne Rd. CITY Eastham STATE MA ZIP 032642 TEL FAX CELL EMAIL SCOTTRDUGAS@YAGHOO.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Mfg) CITY I ai'w,pv , MA DATE [ as as PERMIT# JOBSITE ADDRESS 1/CCIAOn_ Sk-ee+ . OWNER'S NAME _ At (I, OWNER ADDRESS TE ig,g • L Litt b FAX TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL [I RESIDENTIAL 71 PRINT CLEARLY NEW: RENOVATION:D REPLACEMENT: ni PLANS SUBMITTED: YES [j NOD FIXTURES 7. FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB . . � _. _ _ ' - .i - _ '` _ CROSS CONNECTION DEVICE 1; DEDICATED SPECIAL WASTE SYSTEM 1 DEDICATED GASIOILfSAND SYSTEM 1 .c.? i' z ° �'. ate., DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ! 111 DEDICATED WATER RECYCLE SYSTEM ,IMIIIIIIIM01,111111MM WIRMINIM111111_, DISHWASHER tominummitatiastioi ostitior _ DRINKING FOUNTAIN '_ . `-- .' is - --.- FOOD DISPOSER I t ` � WEI 111,1011111111111Elt :_,r FLOOR 1 AREA DRAIN' - INTERCEPTOR (INTERIOR) ' KITCHEN SINK ON MIME IMMINNITIO _ ;;mom LAVATORY ROOF DRAIN u SHOWER STALL 'i 11111111111111 IOW -. AMIN SERVICE/ MOP SINK -- --___`; ;TOILET -1111LIMO MM. URINAL _ , WASHING MACHINE CONNECTION ', _1 _ 4 £ WATER HEATER ALL TYPES Mar �~ s --- WATER PIPING li :.... _ .... L r OTHER (4„Se ► . , _ I, . f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES gi NO 11 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE OF INDEMNITY [' i 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 i.~I AGENT SIGNATURE OF OWNER OR AGENT l 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 P ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Bich' -D aS Tm {� LICENSE # IL1MJ S GNAIRE MP ' JP U CORPORATION#100153' 1S I1PARTNERSHIPD# ry LLC U# COMPANY NAME 1 � ''D L. � 7 I ADDRESS 8 Aefule Rdk_ CITY L_ EastiA. I STATE [/ 141 ZIP w.loti a TELL 4:04a. 73-1 7'1s1 FAX [ CELL <So6 ?3'7sr EMAIL FT, d" °`` a�`00 r� '. CO