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Home My WebLink AboutBLDP-22-003240 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/7/21 PERMIT# BLDP-22-003240 JOBSITE ADDRESS 16 HARVARD ST OWNER'S NAME Jeanette Kende P OWNER ADDRESS 16 HARVARD ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES ' FLOORS— RSM 1 2 3 4 5 , 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 WATER HEATER 1 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❑ 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. PLUMBER'S NAME John Kane LICENSE W755 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOHN KANE ADDRESS 39 MONOMOY RD CITY S YARMOUTH STATE MA ZIP 026641984 TEL FAX CELL EMAIL sjk1725@gmail.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 • MASSACHUSEi f'S UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING W ORK MA. DATE Dri_ 7 Zl PERMIT# Z2- 3240 JOBSITE ADDRESS 1 6 rl Gr"V u r cl S t P OWNER'S NAME 7 ea ►.. {c f'�e vl 6 c OWNER ADDRESS 5 4 rn c TEL 1(bO S r.x TYPE OR OCCUPANCY TYPE: COMMERCIAL PRINT EDUCATIONAL 0 RESIDENTIAL I�L CLEARLY NEW;❑ RENOVATION: REPLACEMENT:• LACEMENT:❑ PLANS SUBMI I i ED: YES 2. FIXTURES URc`5 T./ � NOFLOOR— BSMT I 1 2 3 e I BATHTUB I ° I 1 I 8 9 I 10 I l i 12 1 13 i4 I CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GRE..ASF SYS DEDICATD GRAY VV-ATER SYS I DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN I DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN I INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN-' SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL T YPFS 11 VVAT- PIPING OTHER COVRA I have a current liability insurance policy or its substzntial equivalent which, meets the Ch.requirements of MGL 14_. Yes q ' Et No IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a 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 Owner's Agent CHECK ONE BOX ONLY: OWNER 0 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 NANIE J�h� l�U nt / • SIGNATURE LIC# a 7,r b MP❑ JP 13 CORPORATION ION ❑# PARTNERSHIP ❑# 1J LLC ❑# COMPANY NAME I<U✓►e- I<o v, f r U c l=l i,9 ADDRESS: 3 9 E r a ►i o rn o P2 c. • CITY 5- yormou-i-P. STATE 1614 ZIP U a-6 6 44 EMAIL `J J l� 11 a S e 9 M cr.'/ G O y� TEL CELL 0 ` 6 ffS `56 5-6 FAX