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Home My WebLink AboutBLDP-22-006866 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/26/22 PERMIT# BLDP-22-006866 JOBSITE ADDRESS 162 OLD MAIN ST OWNERS NAME frances hoffman P OWNER ADDRESS 162 OLD MAIN ST SOUTH YARMOUTH,MA 02664-4524 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO El FIXTURES • FIOORS—. BSM 1 2 3 4 5 - 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 Christopher Nilsen LICENSE SP77 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CHRISTOPHER J NILSEN ADDRESS 6 GALFRE RD CITY LAKEVILLE STATE MA ZIP 023471700 TEL FAX CELL EMAIL beak8277@aol.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES ok L X ..,g4 .�/ Yes No THIS APPLICATION SERVE AS THE FEES S PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK s=? CITY/TOWN `I�f ifl 'U 1 r/ MA DATE S 07‘ PERMIT# JOBSITE ADDRESS /G v2 OW /"1/-11 I S< OWNERS NAME �� f�� POWNER ADDRESS 5�i1l Sf�� TEL < /9 5--F-Al IL.7 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[Q PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:a-- PLANS SUBMITTED: YES 0 NO❑ FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB j _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK , LAVATORY 1, vZ ROOF DRAIN [ RECEIVE______P I ' 1 SHOWER STALL SERVICE/MOP SINK URINAL MAY 2-b 2022 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES iIUILrl N G OfP>JTMEINT , WATER PIPING I �y _, OTHER —_ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E 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. CHECK ONE ONLY: OWNER 0 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 witty all Pt n the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /v/ '(/i G�j PLUMBER'S NAME L-rit73 r �LI/�/ Ai/L'5 C/ LICENSE# /T SIGNATURE MP Er JP❑ CORPORATION 0# PARTNERSHIP❑# LLC❑# COMPANY NAME rLu to bta, ADDRESS 6 ALA/e I�G� CITY !AAirlilZ-1 r STATET/? ZIP_ G7 397 'T 9' �) TEL Jy /7" -/�./�I /�. FAX C a 7 yy-5�/ EMAIL FJF/� 5� 7 < e`iez_i" bEIW $,_7 7 0 461- - (--d/24 CAsii Iouc%