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Home My WebLink AboutBLDP-21-003831 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/11/21 PERMIT# BLDP-21-003831 11i=% JOBSITE ADDRESS 446 ROUTE 6A OWNER'S NAME COX JOSEF PAUL P OWNER ADDRESS COX D MELISSA 446 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:Cl PLANS SUBMITTED: YES CI NO❑ FIXTURES 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 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 WATER PIPING 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❑ 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 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. PLUMBERS NAME Gregory Selfe LICENSE 26714 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME GREGORY A SELFE ADDRESS 41 SPRINGER LN CITY WEST YARMOUTH STATE MA ZIP 026734930 TEL FAX I I CELL I I EMAIL l ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No r7/q THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ `/ / 6 ✓K FEES$ PERMIT# >!!!2//} / G° 3Jk PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK (_ ;tttt CITY/TOWN Ytiletro MA DATE PERMIT # �. -I�T'-I- I- R3 JOBSITE ADDRESS gv6H OWNER'S NAME C 0 OWNER ADDRESS LP-1 b gr b Fl TEL :CVMC—'>6a' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL n RESIDENTIAL, PRINT CLEARLY NEW: El RENOVATION:. REPLACEMENT: ❑ PLANS SUBMITTED: YES n NO n FIXTURES Z FLOOR--* 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK I LAVATORY � � --•.r.q,,�w ROOF DRAIN E' C SHOWER STALL ""�° Zj SERVICE / MOP SINK JAN TOILET O 2a2 URINAL WASHING MACHINE CONNECTION t�UI DING t—,6 1 WATER HEATER ALL TYPES 'ANT WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES1A 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 ❑ AGENT El 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 P 'nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER'S NAME r - ? &Mg' ni.s-o, LICENSE # a6 /f tV nd ®IGNA RE MP JP 1Cj CORPORATION (1 # PARTNERSHIP El # Lc n # COMPANY NAME CrcleDRySetce-7ttinRn "Isele`41`e ADDRESS '1 ' SP e ' ^�-�K- CITY • yrs- rrn°,'` STATE al A' ZIP 04- 13 TEL FAX CEL :0V)Th g ^ 1 (i34 EMAIL Ce Ic,.Q 1-1 plr YA-hco. ccoyn .