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Home My WebLink AboutBLDP-22-005610 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/4/22 PERMIT# BLDP-22-005610 JOBSITE ADDRESS 908&928 ROUTE 28 OWNER'S NAME BASS RIVER REALTY LLC OWNER ADDRESS 113 PLEASANT ST SOUTH YARMOUTH,MA 02664 TEL P TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: D RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO El FIXTURFS • 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 _ URINAL WASHING MACHINE CONNECTION _ 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 ❑ 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 Gough LICENSE#A088 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOHN B GOUGH ADDRESS 24 GREAT WESTERN RD CITY HARWICH STATE MA ZIP 02645 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES � a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t ! n n :— CITY MA DATE / PERMIT# JOB TE ADDRESS fiqrx2If OWNER'S NAM �f/ tT POWNER ADDRESS /V ,�L� TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: Er PLANS SUBMITTED: YES ❑ NO FIXTURES 7 FLOOR-; 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY REC EIVE ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK _ M 31 Z022 TOILET URINAL RUILDING UEPARTM WASHING MACHINE CONNECTION By. �-- - 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 ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ir 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 . e t ue and accurate to best f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i co plia :- with II P ent pr vision of the Massachusetts State Plumbing Code an Chapter 14/of the General Laws. r PLUMBER'S NAME / LICENSE #/a) --r 11VN URE MP I JP n CORPORATION icy PARTNERSHIA1 # LLC Ft1�l COMPANY NAM /' e ,rt;/ 7- i' )' RESS O676"4/Ce}(15 /r12C" CITY //iCl60/ Cli - STAT� 0 r' 2 1d ZIP _ p�j �S TEL ,SOIL 7c)-0 S,V) 6br FAX CELIst. /7 513 EMAIL Xr(c;-)e-9-C.. 6--j,k,cci: