HomeMy WebLinkAboutBLDP-22-001753 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 9/27/21 PERMIT# BLDP-22-001753
JOBSITE ADDRESS 59 NAUTICAL LN OWNER'S NAME Joshua Avery
P OWNER ADDRESS 59 NAUTICAL LN SOUTH YARMOUTH,MA 02664 TEL ]
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW: ❑ RENOVATION ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURES FLOORS—a RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1'1._
BATHTUB 1
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM 4
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
ROOF DRAIN _
SHOWER STALL _
SERVICE/MOP SINK
TOILET _ -•
URINAL
WASHING MACHINE CONNECTION
WATER HEATER
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 El 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 Denis Cremins LICENSE#1662 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ADDRESS P.O. Box 1930
CITY N.Eastham STATE MA ZIP 02651 TEL
FAX CELL EMAIL dcremins@comcast.net
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes Na
THIS APPLICATION SERVE AS THE ❑ ❑
FEES S PERMITS
PLAN REVIEW NOTES
CA
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w;_ --s... ._1VIASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORKMIIAIMzE= CI OWN / t7ff �T MA DATE PERMIT # L ? — i / S 3
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.b„ . o JOBS TE ADDRESS '5 f ii
/ 9'4 ,,J Lev �f OWNER'S NAME S '
OWNER ADDRESS TEL FAX
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bYPE ,1C�tJPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY--d •Z. m : ❑ RENOVATION: ❑ REPLACEMENT: ( PLANS SUBMITTED: YES ❑ NO ❑
FIXTURES Z FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I _
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
URINAL
,
WASHING MACHINE CONNECTION -
WATER HEATER ALL TYPES
WATER PIPING I _
OTHER
INSURANCE COVERAGE: r
i insurance policyor its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO ❑
I have a current liability s q q
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE(OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
i
LIABILITY INSURANCE POLICY [tom 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 E 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 t, e and accur to best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be i tpliance with P rtinen provision of the
Massachusetts State P umbing Code and Chapter 142 of the General Laws.
J //EY/2
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PLUMBER'S NAME E.�,�i..� �`' ' C/�'�'1 '�-� LICENSE # SIGNATURE
MP ill JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # _ LLC ❑ #
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-/ 6/' t �1 P j' ADDRESS . .�v - / /J (3 ---- —
COMPANY NAME J � /
CITY A', OH <17474/4 STATE 44/ ZIP /—' 5 ' TEL 77y-��.s=�
FAX CELL
EMAIL ,?/ ?1Ø//VX{