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HomeMy WebLinkAboutBLDP-22-001261 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u�� T CITY YARMOUTH MA DATE 9/3/21 PERMIT# BLDP-22-001261 ., JOBSITE ADDRESS 61 EARLY RED BERRY LN OWNER'S NAME Jason Kane OWNER ADDRESS 61 EARLY RED BERRY LN YARMOUTH PORT,MA 02675-1904 TEL r TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YESD NO 0 FIXTURES • 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 1 SERVICE/MOP SINK TOILET 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 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Douglas Langtry LICENSE#1305 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DOUGLAS P LANGTRY ADDRESS 1268 ROUTE 28 CITY S YARMOUTH STATE MA 7 ZIP 026644459 TEL FAX CELL —1 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Ves No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMITS PLAN REVIEW NOTES x :._ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK = a= YARMOUTH 9/2/2021 2 (Z(o > ( c,:tif-r;� ITY _ MA DATE PERMIT # . < 61 EARLY REDBERRY LANE JASON KANE c D ! JOBSITE ADDRESS OWNER'S NAME LLI t; t rSAME 410-294-7537 FAX OWNER ADDRESS TEL Iz TYPE OF? OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL n RESIDENTIAL n 0,� L-._..PRINT-i :__CLEARLY 11NEW: __ RENOVATION: 0 REPLACEMENT: ❑ PLANS SUBMITTED: YES 7 NO ■ 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 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 1 SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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 IN:$URANCE POLICY 0 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 n 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 accura to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with Pe nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. — -Z7 PLUMBER'S NAME DOUG LANGTRY LICENSE # 11305 2S GNAT RE MP 0 JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC Li # 3081 COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28 CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367 FAX 508-619-3367 CELL EMAIL DOUG-AQUA©COMCAST.NET 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