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Home My WebLink AboutBLDP-23-004623 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK :p. CITY YARMOUTH 1 MA DATE 2/21/23 PERMIT# BLDP-23-004623 —`aim ffi1E ' JOBSITE ADDRESS 23 LEWIS BAY BLVD OWNERS NAME GALLAGHER BRIAN E P OWNER ADDRESS (GALLAGHER JENNIFER A 2 OLD HARRY RD SOUTHBOROUGH,MA 01772 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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❑ 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 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 Anson Celin LICENSE 32655 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANSON CELIN ADDRESS 26 Capt. Blount Rd CITY South Yarmouth STATE MA I ZIP 02664 TEL FAX CELL —I EMAIL ansoncelin@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITH PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK MO CITY `''i Nrclj c Can MA DATE 2-2-1-Z:,3 PERMIT# JOBSITE ADDRESS G S !6.-/1/, s `>4 �}.V!') OWNER'S NAME -;, Ci r1 ( 1•1(Al 1lti_,- POWNER ADDRESS L- `e Lv, S 13xtc.' (Li,',') TEL .SCb -33 0 Z/]L FAX TYPE OR OCCUPANCY TYPE COMM CIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:di REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-4 BSA/ 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 I DEDICATED WATER RECYCLE SYSTEM , DISHWASHER • DRINKING FOUNTAIN ' FOOD DISPOSER - *-- FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / ' LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET , URINAL WASHING MACHINE CONNECTION I---- WATER HEATER ALL TYPES / WATER PIPING OTHER f ' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES UV NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY 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 1, 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 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 `*Y, i'4 /(---- PLUMBER'S NAME LICENSE it 3Z 5S. SIGNATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME C t'I ikl Pligrriiifj A ADDRESS 2 6., (u i ,,-t /3/6�,/f ✓2 0 CITY STATE_%i f A-! ZIP v '�11(, ( L( TEL 3'- '' L/Ci-4 JGL.. FAX CELL EMAIL ✓4n.S c.r7(f-/i CC ei,Z/V/, -C c,r yl ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES