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Home My WebLink AboutBLDP-22-005774 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/11/22 PERMIT# BLDP-22-005774 =, JOBSITE ADDRESS 60 ICE HOUSE RD OWNER'S NAME Alan Shawcross P OWNER ADDRESS 60 ICE HOUSE RD SOUTH YARMOUTH,MA 02664-4112 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTURES • FLOORS BSM 1 2 3 4 j 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 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 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 Anson Celin LICENSE 32655 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP El# LLC El# COMPANY NAME ANSON CELIN ADDRESS 26 Capt. Blount Rd CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelin@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK R _= `f, V E1b `'_.X1461 tiG4r/Y/64.4A MA DATE 1 +--g,-7:7- PERMIT# 22- s- 'i JOB ADDRESS Co 0 ..(-�ccAZ:X.4 Se ��.0 OWNER'S NAME j�F/ O S i-�C�S's API 8 202 j ER ADDRESS G G I4 'Viz- :ce F t TEEM /�-�I4L�..„,3,FAX [3Ult_R> ADFi;RTOCOUIPANCY'TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL Hy — CLEARLY NEW:❑ RENOVATION:I1--REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-, BSM 1 2 3 4 5 6 7 B 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 _ DRINKING FOUNTAIN , FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) - KITCHEN SINK _ _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET I URINAL i 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 0 IF YOU CHECKED YES, PLEASE INDICATE TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND 0 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. T - CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z. SIGNATURE OF OWNER OR AGENT I 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 compli ce with all Pertine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME z LICENSE# 12G5 5 SIGNATURE MP❑ JP[U" CORPORATION❑# PARTNERSHIP❑.# LLC ID# COMPANY NAME Cf,?) (13y, tjvr)1.1--- tA ', ,A��1 ADDRESS �, Ccf(*it't'l 1 tCI'.1)1- 2T> CITY S,k_ �`ierti j STATE /`4/ ZIP O 4 G Zt TEL ) 7-4 G--ti17 FAX CELL EMAIL Arbc.n LE�ei l yy fr. Cc ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT it PLAN REVIEW NOTES 1