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HomeMy WebLinkAboutBLDP-22-005997 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/19/22 PERMIT# BLDP-22-005997 rl JOBSITE ADDRESS 21 TELEVISION LN OWNER'S NAME STANDRING HAROLD J(LIFE EST) P OWNER ADDRESS 21 TELEVISION LN WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES 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 1 DRINKING FOUNTAIN FOOD DISPOSER 1 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 Pedinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Richard Ahern LICENSE#1340 SIGNATURE MP I JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD C AHERN ADDRESS 67 Hayward Dr CITY Stoughton STATE MA ZIP 020723811 TEL • FAX CELL I EMAIL rich@corvoproperties.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 j '.-. ' GI A.J. ,,t r..CP��Z MA DATE /9 Z Z PERMIT# 7-2— ��q S'1 A' • 1 9 (}22BSI'E f DDRESS 2( /14 di Stet./ ,L_.,ill OWNER'S NAME/ ✓ PL �l / pp ADDRESS (/ ,�/ �J l / 7 :,u i ��4G u E HA i�9 n r T N�,Pi L</ Liu t04i' /�'t�t- TELQ/ 6 �47/ FAX •Y - -- , Y TYPE COMME CIAL❑ EDUCATIONAL ❑ RESIDENTIAL Er PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES 7 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 T 14 BATHTUB 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 I AREA DRAIN _ INTERCEPTOR(INTERIOR) KITCHEN SINK / • LAVATORY ' - — ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET "2-, - 1 URINAL I WASHING MACHINE CONNECTION " j WATER HEATER ALL TYPES / _ WATER PIPING / OTHER — INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ErNO 0 IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND ❑ i OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT El SIGNATURE OF OWNER OR AGENT L',.I I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac uaate 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 th all P ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ®/ PLUMBER'S NAME LICENSE#!/ U . SIGNATURE MP El JP❑ /CORPORATION❑# PARTNERSHIP❑.# LLC u"1(� COMPANY NAME I.Pf,� 7f 9 If /.6 ADDRESS 7/ ,i zr 't CITY ` rial 2410V .7 STATE M4 ZIP °i o71 TEL '3/ '' je&�? FAX CELL 7&/ ��f eil / EMAIL r/e' ALl!ez✓YrL �,- 6,.,I r_C.,'YI c 0 z � 0 U W w - I O In z II o a 0 a a LLI 2 W . tL 0 0 U Z z 0 x