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Home My WebLink AboutBLDP-22-005204 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK rr - CITY YARMOUTH MA DATE 3/17/22 PERMIT# BLDP-22-005204 f�_. JOBSITE ADDRESS 7 PINE GROVE VILLAGE OWNER'S NAME THOMPSON MARGARET C TR P OWNER ADDRESS MARGARET C THOMPSON LVG TRUST 226 RIDGEFIELD RD WILTON,CT 06897 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Ea PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • Fl OORS—, 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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. PLUMBER'S NAME Michael Mcbride LICENSE1f0681 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 "'� �I E '�1l'jt'u" [J;^ T'- MA DATE Z. PERMIT# 7;1 - S2i%7 R • ITE ADDRESS 7 /7) (�' C� i,� iL/•,1 i='1- OWNER'S NAME�I ;'1,y 15 air 7 _ OWNER_ADDRESS TEL FAX ' _TYPE Off, , OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL Li RESIDENTIAL PRINT IV CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:(_ PLANS SUBMITTED: YES❑ NO f 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 ---_I DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ,-, DEDICATED WATER RECYCLE SYSTEM DISHWASHER • -.__I DRINKING FOUNTAIN FOOD DISPOSER I ____, FLOOR I AREA DRAIN ._______i INTERCEPTOR(INTERIOR) KITCHEN SINK • LAVATORY ROOF DRAIN I I SHOWER STALL SERVICE/MOP SINK TOILET , - �� URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ' / ' WATER PIPING OTHER INSURANCE COVERAGE: i 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 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 1 Massachusetts General Laws, and that my signature on this permit application waives this requirement. 1� CHECK ONE ONLY: OWNER CI AGENT ❑ SIGNATURE OF OWNER OR AGENT 1Q,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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of,theGeneral Laws. J 1 i' I l(1 � PLUMBER'S NAME (�� I i `1�1.r' !ti c..3 f ` C�'� LICENSE SIGNATURE O , MP ❑ JP❑N` CORPORATION❑# / - PARTNERSHIP❑.# LLC❑# COMPANY AME G .L.. n. itV p 7 .�- 1-- ADDRESS / j �/1 [-) ��J G CITY ,1 i1 1 5STATE /1-1"4- ZIP 6 2 6 O/ TEL 77( ��f / Z r FAX CELL EMAIL 7 rl 5 e,^, vj s�!.A ("2 c-u Ce .j,'��'1,- ` ((i'� J 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 •