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Home My WebLink AboutBLDP-22-005158 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4,m! CITY YARMOUTH MA DATE 3/16/22 PERMIT# BLDP-22-005158 JOBSITE ADDRESS 8 MCNAMARA AVE OWNERS NAME HOLLAND NANCY T P OWNER ADDRESS 8 MCNAMARA RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION,El 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK - TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:septic reroute 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❑ BOND El OWNERS 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Patrick Dempsey LICENSE 16176 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PATRICK J DEMPSEY ADDRESS 26 LYME ST CITY EAST WEYMOUTH STATE MA ZIP 021891023 TEL FAX CELL EMAIL none 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 —_,D` ° CITY i ICA rY>(�(�Bch MA DATE 3 ,I 5/2 Z PERMIT# • 2 2' CI 5 Y JOBSITE ADDRESS IS MC,0G rC-. N"‘a. OWNER'S NAME 4.A.1(1( .-( ,-1Cy (.4g\ - P OWNER ADDRESS 1�� i \1�{ 3 c `I�C.x �GT EL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL Lit PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:E. PLANS SUBMITTED: YES❑ NO❑ 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 LAVATORY _ ROOF DRAIN _ SHOWER STALL , SERVICE/MOP SINK . TOILET URINAL , WASHING MACHINE CONNECTION , WATER HEATER ALL TYPES WATER PIPING , OTHER _ -F►L C c-.c X INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES44 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY, OTHER TYPE OF INDEMNITY 0 BOND 0 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 ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application 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. lian with all P ent provision of the ;:;;;:: Piu ing ode an Chapter of the General Laws. LICENSE# y�i 7�g IGNAT E i� MP Ok JP M CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ��,`�i�(A( --1- DQA/�M? 71,,, DRESS 35 Pic., ( -(,2- I C00 Q ( ram. CITY STATE ZIP TEL - , 1 ea 0667 FAX CELL 7S 1 710 0667 EMAIL