The URL can be used to link to this page

Home My WebLink AboutBLDP-22-004785 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 10 ram' CITY YARMOUTH ] MA DATE 2/28/22 PERMIT# BLDP 22 004785 ti JOBSITE ADDRESS 117 FREEBOARD LN OWNER'S NAME COTTO KATHERINE s P OWNER ADDRESS 117 FREEBOARD LN YARMOUTH PORT,MA 02675-2070 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES NO El 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 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 Mark Chalker LICENSE IP313 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK R CHALKER ADDRESS 483 COUNTY RD PO BOX 43 CITY MONUMENT BEACH STATE IMA I ZIP 025530043 TEL FAX CELL EMAIL chalkerfuel@comcast.net 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 virtai, CITY YQ(tntO Ulk Y\ MA DATE 2 f 22 PERMIT# j L- L S T r 7 JOBSITEADDRESS \ Fce..e)ooctrd In OWNER'S NAME3'.( Q OQU`Q+¢.I OWNER ADDRESS TELL 23S' ZS37- FAX •7` TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALIS PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:71 PLANS SUBMITTED: YES❑ 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 E C E E a! r D SHOWER STALL /lfi SERVICE 1 MOP SINK I y t _ r TOILET f-CES �rj � URINAL WASHING MACHINE CONNECTION BUiLDI,vG UcNAPTr4EN7 j WATER HEATER ALL TYPES T— I 1-3) — L WATER PIPING OTHER i • ._ rclow �PC4�Q.r►}�( INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESX NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY .1:21, OTHER-YPE 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 j Mass h setts General aws d that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ,1?5, AGENT ❑ SIGNATURE OF OWNER OR AGENT !�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 i o plia e t II din rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME '.`PlMc4,11( ()nal LICENSE# 3Z�13 NATURE MP❑ JP j54 I' CORPORATION ❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME M c1, e `d 1 ADDRESS '155 m C�l,�y CITY �ov 1lQ,ri�- $QJGC \ STATE MA ZIP ��553 ( TEL FAX CELLS 08 '33'\ ' OgI2- EMAIL 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