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Home My WebLink AboutBLDP-22-004749 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 2/25/22 PERMIT# BLDP-22-004749 ` JOBSITE ADDRESS 61 OUT OF BOUNDS DR OWNERS NAME CAFFREY PATRICIA E P OWNER ADDRESS 61 OUT OF BOUNDS DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES El NO 0 FIXTURFS • FLOORS—r BSM 1 2 3 4 5 6 7 8 9 10 11 12J.3 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 BOND❑ OWNERS 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 at 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 'Joseph Madden LICENSE 3$1558 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC Ott COMPANY NAME IJ.M.MADDEN COMPANY ADDRESS 15 Perrys Way CITY 'Harwich I STATE MA ZIP 102645 ' TEL FAX 15555555555 1 CELL 17747223545 1 EMAIL info@maddencompany.biz ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 0 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �� " `L Z—�I�`1�) a+ VV ✓�A► MA DATE )7W ,'� PERMIT# rl�_ CITY/TOWN l��/lv - C I Qv f oZ ` DWNER'S NAMEVc�. 6sz.,_Eiyfifcix----_,, JOBSITE ADDRESS ' P OWNER ADDRESS TEL 52A.- 1)0 g"748 F FEB 2 4 2022 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT PLANS SU pl ' �IacIN7 CLEARLY NEW:❑ RENOVATION: [� REPLACEMENT: ❑ _._. {FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 3 14 BATHTUB - eKUSS CONNECTION DEVICE DEDICATED SPECIAL WASTLSYSTEM i I ! DEDICATED GAS101USAND SYSTEM � I DEDICATED GREASE SYSTEM , i ! I ' ! DED C TrD GRAY .,,. WATER SYSTEM . . DEDICATED WATER RECYCLE SYSTEM DISHWASHER - 'DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY I • ROOF DRAIN SHOWER STALL I ` SERVICE I MOP SINK - TOILET 1 - URINAL WASHING MACHINE CONNECTION I . WATER HEATER ALL TYPES ( WATER PIPING 1 OTHER . INSURANCE COVERAGE: liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES d NO ❑ I have a current Ila ttY IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Of 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 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 applicationill application true and it ur I t mine bestprovision knowledge and that all plumbing work and installations performed under the permit issued for this Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME >>e-- dr\_ LICENSE# 111553 SIGNATURE MP❑ JP d CORPORATION ❑# S- PARTNERSHIP❑# LLC❑# COMPANY NAME-5W / CorAk2pAr ADDRESS/c Q' :ccys LJ�Y CITYAr./.0"...)6 cill STATE/1- ZIP 4;qC TEL 1-(--7�1.-' 35115' FAX CELL EMAIL p f.iv`, cif b J