The URL can be used to link to this page

Home My WebLink AboutBLDP-21-002052 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK + Fa CITY YARMOUTH MA DATE 10/19120 PERMIT# BLDP-21-002052 (� " JOBSITE ADDRESS 130 CROWELL RD OWNERS NAME TEXEIRA JOSEPH P P OWNER ADDRESS TEXEIRA PATRICIA 301 WILLOWGATE RISE HOLLISTON,MA 01746 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES a 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 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 1 URINAL WASHING MACHINE CONNECTION 1 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 D 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 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 at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME matthew Coleman LICENSE 3g368 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MATT COLEMAN PLUMBING AND ADDRESS 8 Pine Pond Rd HFATING CITY Brewster SIAIE IMA I ZIP 02631 TEL FAX CELL 9788854343 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES es No (/AL / y/LO CI=S THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK L ill� CITY [ �' 1TFarr4d2ci., vt,, MA DATE 14trW � �PERMIT # � " gi-eV JOBSITE ADDRESS k5U '' - 1 -.0 i OWNER'S NAME r S OWNERADDRESS ! 1 �ocu A i TEL a132FAXr J ,ZA- TYPE IC ,�OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL v PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES _,I NO FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB , t�— : �^ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM — DEDICATED GRAY WATER SYSTEM __ __ DEDICATED WATER RECYCLE SYSTEM if DISHWASHER DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY , - _ _. ROOF DRAIN .._ � { _. ... SHOWER STALL . , _ __ SERVICE / MOP SINK TOILET 1 1 URINAL _ WASHING MACHINE CONNECTION 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 j NO Li IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY r1 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 AGENT I 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. /1 � l� �Z — G l Ir LICENSE # SIGNATURE PLUMBER'S NAME } . � �_ �.__.__...__�__ 9'r72 �j MP i JP Li CORPORATION # PARTNERSHIP# LLC[ # € COMPANY NAME' S eiilL°6 a?jI(x.tisi-'�� < ��r,., 'i� •ADDRESS [ C e foi c _.• • -- _ .�..,._ �a CITY r� el� ST TE LriA ZIP I`� TEL I/_g ' � -` ,.: I FAX / CELL ppti±fic,,e(yan l t� ��•k' EMAIL _ r_ tittio 1(.10.g Yotip,411/4 .5...20K.. ., :A .