HomeMy WebLinkAboutBLDP-22-004977 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 3/8/22 PERMIT# BLDP-22-004977
JOBSITE ADDRESS 8 BURCH RD OWNER'S NAME MARK KYER
P OWNER ADDRESS 8 BURCH RD SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW:0 RENOVATIONS,0 REPLACEMENT:0 PLANS SUBMITTED: YES NO 0
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 2
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER
WATER PIPING 1
OTHER 1
OTHER DESCRIPTION:ice maker
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❑ 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 Mark Hazleton LICENSE 18732 SIGNATURE
MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME MARK A HAZLETON ADDRESS 275 MEIGGS BACKUS RD
CITY SANDWICH STATE MA ZIP 025632750 TEL
FAX CELL EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
rtrnamer
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
_---=---,- .uf-:--_--•_ ,./.k.
"— CITY 9�C�f"G';i�� MA DATE ' • .F.. -2(-')Z Z PERMIT# / - q5 ri
JOBSITE ADDRESS S 56, F"C)+ 'D OWNER'S NAME 1414e ic. ig ter
POWNER ADDRESS TEL 17;&7 TEL 97Z 772 657/,//11/4X
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 27
PRINT /
CLEARLY NEW:❑ RENOVATION:hd 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/OIL/SAND SYSTEM
•
_ DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER _ l ,
V DRINKING FOUNTAIN
FOOD DISPOSERII
_ _
X FLOOR!AREA DRAIN a
E E 1 l
INTERCEPTOR(INTERIOR) - - _
KITCHEN SINK I ,
LAVATORY r '2.. I '. 0 ; • I I
ROOF DRAINI
\i SHOWER STALL Q NG D•PART ENT
•
SERVICE/MOP SINK iy _- -- - -
`. TOILET Z
N URINAL
WASHING MACHINE CONNECTION 7
WATER HEATER ALL TYPES
IWATER PIPING /*
; OTHER
VI Tc.e ))-xlrA,.Ae
INSURANCE COVERAGE:
i 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
UABIUTY INSURANCE POUCY Gli/ 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
1 Massachusetts General Laws,and that my signature on this permit application waives this requirement.
T _ CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
1 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 knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertine pro ' io�e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LICENSE#/3 731i (j TURE
MP iZr JP❑ CORPORATION 0# PARTNERSHIP❑.# LLC 0#
COMPANY NAME /Y/t'-7 4OV /' '7#' ADDRESS t' 7S /1ipe'6cfs- 'G,.--s •Ic v
CITY `--�° l t / C /, STATI 'a ZIP U4-,c6 V. TEL 77 -3/3'f�-S -
FAX CELL ✓ EMAIL.J1,' i i �e 7Z //�' / O.'/i C CT„/a--7
C lC4104 /S-0 —
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