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Home My WebLink AboutBLDP-22-002634 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/9/21 PERMIT# BLDP-22-002634 JOBSITE ADDRESS 77 BAXTER AVE OWNERS NAME STEERE JOHN CALVERT P OWNER ADDRESS C/O ROBERT C STEERE P 0 BOX 7551 CUMBERLAND,RI 02864 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL CI RESIDENTIAL ID PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—, RSM 1 2 3 4 4 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 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❑ 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 Braddock LICENSE V092 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME IJOHN E BRADDOCK ADDRESS 6 GARNER AVE CITY JOHNSTON STATE RI ZIP 029192308 TEL FAX I CELL I EMAIL ljjcon94@me.com 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 •.1 ./.1,,,,ii k '' ' - --'' ''' CITY VIAr IY\- 0:1-k \Iv.. .-..../44:p MA DATE I I - 1-{ - ... 1 PERMIT # 2-1-- Ve 11 JOBSITE ADDRESS _ :7 -.7 . OWNER'S NAME P OWNER ADDRESS _(,57.(rirs Er,,,-).__D.2._ (S___6-47.7.4-1/. ./Wj•-- _ TEiNov) 6 -. \i/"A--. rrr-vvf--K. rh,A.-- tibl 6 11 TYPE OR OCCUPANCY TYPE 'COMMERCIAL El] EDUCATIONAL 0 RESIDENTIAL A PRINT CLEARLY NEW: Li RENOVATION: V REPLACEMENT: I:=1 PLANS SUBMITTED: YES 0 NO Li FIXITURE S 1 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 --+ BATFH U13 CROSS CONNECTION DEVICE — DEDICM ED SPECIAL. WASTE SYS I.EM _ DEDICATED GAS/Oil/SAND SYSTEM -.. . - -- DEnICA11_66R17.ASi SYS I EM — ' - I DEDICATED GRAY WATER SYS I LM -I— ----t DE ilRA I ED \11;A11:5- RECYCLE. SYSTEM 4 --.- ---,-- 4 DISHWASHER 1 DRINKING FOUNTAIN I FOOD DISPOSER FLOOR / AREA DRAIN _ 1 . IIITEkCEPTOIT(11\iTERIOR) _ - _ . --LAVATORY TY ' :"1141 kDiING.- ,„: ;;- .1411(-1 11 _ R001. DRAIN SHOWER S 1 Ali: — ---- _. - SE RVI-C-I / 1C/101.) .STN-i-K D Toitli ----- .2. .•____. __ _ . _____ URINAL Pit 0 8 ,n,. , ____-_, ,__ __. 1 _ WASHINGACHINE CONNEC[ION - WATER HEATER ALL TYPES I ' -----'-. 1 WATER PIPING _ 1 "--------- ........____L:2ZIMEN- 1 --I ----' -------. - , '--- ' -- -----.-------------------- - ------ INSURANCE COVERAGE: — I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Iii NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X OTHER TYPE OF INDEMNITY El BOND 0 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 0 AGENT [1] SIGNA FURL OF OWNER OR AGLN I I hereby certify that all of the details and information lhave sub-rnitted-Oreniered regarding this application are true and accurate to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ith all P inerfprovIsion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,.------ PLUMLit R'S NAME 3--of -k) E 6 r ivo o oat_ LICENSE # /4 0 93 SIGNATURE MI' LX JP [1 CORPORA.I ION [.I # PARTNERSHIP 1-1 # LLC Cil # COMPANY NAME. ADDRESS 4 .6--A--(7•) 4---/ A-1/'-- . ._. _..... ___. ------ ----- on ToH-05 roi-J SIA111 ( -tr--- LIP 0.)---(31 I °I TH L/01 ' c7s----/Li Li-1( FAX .• I-/ 0 1 - 2_ 31 \ „ 17 0 al_L _ 1-1 0. 1 -_-____c 7 sT-- ILI vi.mAIL j j co IQ 9 9 -e--- tY\E-- - CAMt\ C141; , -1 :3