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Home My WebLink AboutBLDP-22-003651 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/30/21 PERMIT It BLDP-22-003651 1 JOBSITE ADDRESS 41 NAUHAUGHT RD OWNER'S NAME CHIN JARROD J P OWNER ADDRESS LAWRENCE COLLEEN L 30 HAWTHORNE RD MILTON,MA 02186 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑ FIXTURES FLOORS RAM 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 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 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 0 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 Ijohn gilmore I LICENSE 18699 SIGNATURE MP ❑i JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PLEASANT BAY PLUMBING INC ADDRESS CITY BREWSTER STATE MA ZIP 02631 TEL FAX CELL EMAIL PLEASNTBAYPLUMBING@COMCAST.NET ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES ,-1Oov MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1�=�5 CITX�. 7olQ J0./k MA DATE 1Z(2`-72. 1 PERMIT# ZZ- 34' 5i JOBSITE ADDRESS uj A)A�)LA( ) 6 C-J OWNER'S NAME CM 1&3 `1 A>Qk0b z- POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:tg, REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO N FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM T__— DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I DRINKING FOUNTAIN y FOOD DISPOSER FLOOR/AREA DRAIN _ _ INTERCEPTOR(INTERIOR) KITCHEN SINK 1 �- E L) LAVATORY I _ I • . .a- . . -� ROOF DRAIN 1 SHOWER STALL { _ ItIFW C `(4 9 2q SERVICE!MOP SINK TOILET I i BUILOLNc' JtPARTME�T i URINAL By WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES I WATER PIPING i _ _ OTHER I 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES g•i 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 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the l' Massachusetts General Laws,and that my signature on this permit application waives this requirement. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L:_l I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in 'a 'th Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMES6 G. u-,4304 LICENSE# ( 67? . SIGNATURE MP j. JP❑ �(CORPORATION #3(p115 PARTNERSHIP❑.# LLC❑# [� COMPANY NAME 1‘C,k5�`1� '�I J cr�Y` 1.A C. ADDRESS 143 Q �A)a c+C & W CITY 5 1_ STATE VA-Ac, ZIP 02.4 I l TEL '7 7 y '?22- Li&'.S1 FAX CELL EMAIL t c.C. AA414.s.hAC T4A C.0 C_1J5 --N44— r 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