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Home My WebLink AboutBLDP-22-000337 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK "r ., CITY YARMOUTH MA DATE 7/20/21 PERMIT# BLDP-22-000337 f;f JOBSITE ADDRESS 13 WEBSTER RD OWNER'S NAME claudia norton OWNER ADDRESS 13 WEBSTER RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL C PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ 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 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION: relocate main drain 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 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 Herbert Healis LICENSE 20177 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME HERBERT M HEALIS ADDRESS 78 STUDLEY RD CITY S YARMOUTH STATE MA ZIP 1026642906 I TEL I FAX CELL I 1 EMAIL Ihhealis@yahoo,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 i, 1.1 1/1 1;S.. C., i: L- MASSACIIUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK E. _ : ' CITY West Yarmouth MA DATE 7/8/21 PERMIT # �- De- 2Z-C�CG33-7 • rid JOBSITE ADDRESS 13 Webster Rd _ OWNER'S NAME Norton C I o ud 4 OWNER ADDRESS same- _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION: ® REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO Q FIXTURES 1 FLOOR-4 BSh1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 r BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM r— DEDICATED GAS/01L/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR) __-- KITCHEN SfNK -_ LAVATORY ROOF DRAIN -- SHOWER STALL SERVICE/MOP SINK - TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER Relocate waste main for 1 _yew septic INSURANCE COVERAGE: • I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 5a NO U IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY K) 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 ifiave 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 wvill be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Herb Healis LICENSE # 20177 SIGNATURE MP❑ JP ® CORPORATION ❑ # PARTNERSHIP fl # LLC ❑ # COMPANY NAME USA Mechanical ADDRESS -__ _7&Studley rd CITY S. Yarmouth STATE Mk ZIP 02664 TEL 508 776 5495 FAX _ CELL ____- EMAIL __hhealis@yahoo.com