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Home My WebLink AboutBLDP-21-007173 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK --;; CITY YARMOUTH MA DATE 6/10/21 PERMIT# BLDP-21-007173 JOBSITE ADDRESS 1014 ROUTE 6A OWNER'S NAME John Callahan P OWNER ADDRESS MARSTONS MILLS,MA 02648-1202 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS 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 1 DRINKING FOUNTAIN FOOD DISPOSER 1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK 1 LAVATORY 1 3 3 ROOF DRAIN SHOWER STALL 1 1 1 SERVICE/MOP SINK TOILET 1 2 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 1 1 OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 Callahan LICENSE 2t1648 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOHN F CALLAHAN ADDRESS 520 S FRANKLIN ST CITY HOLBROOK STATE MA ZIP 023431830 TEL FAX CELL 6177800468 EMAIL johnc.mechanical@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES ‘'24e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY/TOWN 61 1,xJ,-.74/ MA DATE {p-' 0 Cx/ PERMIT#QLDP JOBSITE ADDRESS #//d/r/ 9.h.5','‘,00, OWNER'S NAME -*7.r OWNER ADDRESS TEL /7-7 - 7 AX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL❑ PRINT CLEARLY NEW:(RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES[ ' NO❑ FIXTURES 1 FLOOR-0 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/01USAND 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 `. 3 3 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK r TOILET x_ URINAL WASHING MACHINE CONNECTION >Nc* WATER HEATER ALL TYPES >l, 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 t1d NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY t 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 El 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 with all Pertinent prow ' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME /Si7 doS1/4.�y, LICENSE# SIG ATURE MP 0 JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME i 9��,��p s�7 ADDRESS 007 5� CITY /.. �77owA/j STATE/?/4 ZIP TEL Gl/_ al�v� FAX CELL EMAIL a��