The URL can be used to link to this page

Home My WebLink AboutBLDP-23-001872 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY YARMOUTH _w,uMA DATE 10/7/22 PERMIT# BLDP-23-001872 I' JOBSITE ADDRESS 32 Q RIVER ST OWNERS NAME MAZZIE STEVEN A TR P OWNER ADDRESS MAZZIE FAMILY TRUST 129 BELL ROCK STREET EVERETT,MA 02149 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES t FLOORS 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 SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 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❑ 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. PLUMBERS NAME Dennis Gagne LICENSE 9804 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DENNIS M GAGNE ADDRESS 31 Cherrywood Ln CITY Marstons Mills STATE MA ZIP 026481761 TEL FAX I I CELL EMAIL Igagnedmg5l@aol.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES . '`` RECEIVED tr ' OCT 0 U 021 MAP : Pfigeee • L S'D ',1 CI BOIL , 'AR I NIENT MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERT~ -NSRK--- 4.= i as- CITY _? ? 7 1 MA . DATE / ' -Z- I PERMIT# _ ;' .~ '- JOBSITE ADDRESS L3s X'/C'7"`- - - I OWNER'S NAME p .. OWNER ADDRESS 1 TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL 0-- PRINT CLEARLY NEW: ❑ RENOVATION:[REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1. ION off IIIIIIIIIIIIIFWIII CROSS CONNECTION DEVICE limpitymillwoor jporipm ion imclus'- _l ._. , nil DEDICATED SPECIAL WASTE SYSTEM ,��;I�,�;i�� i DEDICATED GAS/OIL/SAND j111111,11111_1(111111111 m;i.. . _�f ''� -�- �r 'E1� DEDICATED GREASE SYSTEM . .. � imp 111111 - DEDICATED GRAY WATER SYSTEM I �I 1 �: ., r� '111110111110.111111 '�I DEDICATED WATER RECYCLE SYSTEM mliiiiimijoillp.imalitipwiptimismitcwomjimn, DISHWASHER i ±I I . ; MIR,0111 DRINKING FOUNTAIN ILWWW. 1 I FOOD DISPOSER �:'____ _J ii 1 .' Ti i[ FLOOR/AREA DRAIN —' ;1 ,!W.011.1•1010: ; INTERCEPTOR INTERIOR I m - - rr l�plit '1 i KITCHEN SINK M1111.1111/a="1"MIIIMI -;IMI: LAVATORY _.i IROOF DRAIN W; i s a a . . .i ' SHOWER STALL i lW . ( ! ? i ► SERVICE/MOP SINK lf 'M _ -__ ____ -_ - LJ TOILET :� .11101 URINAL MI - ...J. - -- 1111.11111.11111111M-1,1111111WWINCEMUMW WASHING MACHINE CONNECTION Amu_-.. i ,'I __ . L-.. - _ t ti _ _ tigillillr WATER HEATER ALL TYPES fl -i H ' riatiorm WATER PIPING . ► ' i1 11.11.11111111111 OTHER _. �{ 1IIII1 ;ii ■■r II��-iti ' ';rint incincigurimmitimormarmum INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES al NO J . IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY 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. 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 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 aII rtine -i.vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /'" PLUMBER'S NAME JLICENSE# (-1‘,,;,-,,, '-1 1 SIGNA MP ' JP❑ CORPORATION❑# PARTNERSHIP❑4 LLC❑# �, , t ADDRESS 3 , ez a 0 CC -�- 1 COMPANY NAME �I -f.' I � 7 CITY VYIDtg.G i5 ien- CIA_ STATE 11 - ZIP !� 2-4 d� TEL r) 4 7 e 1 FAX CELL I EMAIL &14,./14__Thini6- 451 _CCOL‘ (Akv-v i ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY VINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 'p. wat i F3