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Home My WebLink AboutBLDP-22-001858 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/4/21 PERMIT# BLDP-22-001858 11=0-1 JOBSITE ADDRESS 728 ROUTE 28 OWNER'S NAME PIRATES COVE EAST INC P OWNER ADDRESS 728 ROUTE 28 SOUTH YARMOUTH,MA 02664-5158 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES FLOORS , RSM 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 3 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 4 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 4 URINAL 1 WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER 3 OTHER DESCRIPTION: hose bibb 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❑ 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 Troy Gilbert LICENSE 1#3573 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES 4-- w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK C 7�111� Z CITY I South Yarmouth _ MA DATE [9/28/2021 PERMIT # 1 - t\2 Y JOBSITE ADDRESS : 728 Main Street OWNER'S NAME; Pirates Cove East Inc POWNER ADDRESS same _v- - ...... . .. . . .. . . . TEL FAX L - TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL fl RESIDENTIAL ri PRINT CLEARLY NEW: ' RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES NO I 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 iliww ' DEDICATED GRAY WATER SYSTEM i DEDICATED WATER RECYCLE SYSTEM I . .. DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN 3 INTERCEPTOR (INTERIOR) ite W LLB: op _. . KITCHEN SINK _1,14...._._ LAVATORY ,' 4 ROOF DRAIN _1 . SHOWER STALL '... — i. --::----; SERVICE I MOP SINK wvam > TOILET 4 A _ _ MI : URINAL 1 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER Hose Bib Wash Downs 3 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 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 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 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 Troy Gilbert LICENSE # L13573 _1/7SIGNATURE MP i JP CORPORATION L # _ PARTNERSHIP' # LLC FS. 4350 j COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY South Yarmouth ` STATE MA ZIP 02664 TEL `508-T37-8747 FAX E —1 CELL 508-850-6955 EMAIL [ia@coastalphc corn