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Home My WebLink AboutBLDP-23-003401 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/19/22 y,uPERMIT# BLDP-23-003401 11 JOBSITE ADDRESS 42 MELVILLE RD UNIT 5B OWNER'S NAME Nicolette Asack P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES ' FLOORS BSM 1 2 3 4 5 6 , 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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 0 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. 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 Andrew Leighton LICENSE 16130 SIGNATURE MP 0 JP ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El 111 FEES$ PERMIT# PLAN REVIEW NOTES 50, ASSACHUSEI T S UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WOE ,r�. ` PERMIT �. 3 r Yaryn0S+L._ MADAEfa / ° _01 DRESS HeA d/ lfe_ i' 4 owNEPs NAMI: i0,cbi efrc f�-5 . JaBSITE A . �a OWNER ADDRESS I if _ O EDUCATIONAL RESID 1. i OCCUPANCY !PE COMrr RCA --- TYPE OR occu T PRINT PLANS SUBMITTED:�• YES 3 RE'-L ACEMEN NEW: ' 2 RENOVATION: � u� F. CLEARLY L�. , L E + O -+ ! BSMi t 2 1 .� 4 5 ' E 7 1 8 19r 1 1 . + 1'IXI L�I�.S OR _ �.' _ .. — — - - — = u CROSS CONNECTION DACE _ ow _mi . . DICWASTE SYSTEM EM DEDICATED SPECIAL --_-- - `- ' DEDICATED ED GAS/OIL/SAND SYSTEM ;_._-__-- - --�4- -- _ - REASE SYSTEM `- _--- : . __ - _ .. DEDICATED G _ _. .. _ DEDICATED GRAY WATER., SYS. �� ----- __ ----- - ------ -- z- .: _ _ ._. DEDICATED WATER RECYCLE SYSTEM ^-- . ._ - -�� _ - �� - �-- �. DISHWASHER — - -- --------- ... DRINKING FOUNTAIN AsN --- -- t� DISPOSER FLOOR 1 AREA DRAIN � - ----=�' ---- - .. __ ��: -. I INTERCEPTOR (INTERIOR) ____ - - SINK KITCHEN - .. - __ i - .- LAVATORY �� _ _._: �w�.... ROOF DRAIN ----- �� . . TALC. : SHOWER S - _ . MOP SINK � _-- SERVICE 1 . .. TO .__. _ ... • WASHING MACHINE CONNECTION,ON _ __ ' WATER HEATER ALL TYPES = = WATER PIPING -- - — __. — INSURANCE COVERAGE: ofMCsh Ch. 142 YES NO ,., or its steal equivalent which the I have a current`;a��Y ir�ststanCe policy • i' IF YOU CHECKED'Ca PLEASENDICATE THE TYPE OF COVERAGii BY CH CMS THE APPROPRIATE BOX BELOW ! LIABILITY INSURANCE POLICY a . OTHER TYPE OF INDEMNITY 7. BOND J OWNER'S INSURANCE WAPVER: I am aware that the licensee does not have the insurance coverage required by Chap of Massachusetts General Laws,and that my signature on this permit application waives this requirement CHECK ONE ONLY: 0 ER ; AG SIGNATURE URE OF OWNER OR AGENT I hereby y certify that ail of the details and infort on i i submitted, " or entered regarding this u ue Tr and that all plumbing work end installations performe d d uncle•tte perrnft issued far this application vigl in wail P ion Massathuset S`• Planning Cade and Chanter 1.42 or the G. ?- rah Laws. / . r � �- GNA T UtRE �>a PLUMBER'S DAME ANDREW LEIGHTON _ _ ;LICENSE# 116 304 MP _ JP Ti CORPORA-Mk 3734C !PARTNERSHIP I._ #4F LLC COMPANY NAME HALL OIL COMPANY INC. . ADDRESS 435 R T 134 ^ _ _ j CITY SOUTH DENNIS, _.- =STATE 102 T EL 50$-39$-3$3 i f pax . ;n5R-vAL.3068 i CAL 1 IEMIL i halloilcomi3 - ----