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Home My WebLink AboutBLDP-22-005025 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/10/22 PERMIT# BLDP-22-005025 JOBSITE ADDRESS 97 MAYFLOWER TERR OWNER'S NAME CRAWFORD SIDNIE W P OWNER ADDRESS WHITE DEBORAH 0925 PIEDMONT RD LINCOLN,NE 68510 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 FIXTURES • FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 _DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 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❑ NO 0 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 Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Troy Gilbert LICENSE 26383 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME TROY J GILBERT ADDRESS 39 STATION ST 39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL kathedne@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE EJ El FEES E PERMIT# PLAN REVIEW NOTES • r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK lifffg CITY Yarmouth MA DATE 03/07/2022 PERMIT# • 7-Z- S-32( JOBSITE ADDRESS 97 Mayflower Terrace OWNERS NAME Sidnie Crawford POWNER ADDRESS 119 Barn Rd E Stroudsburg , PA 18301 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL U RESIDENTIAL V PRINT CLEARLY NEW: n RENOVATION: V REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO V FIXTURES 1. FLOOR—► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 ___- CROSS CONNECTION DEVICE 1 . DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM . DEDICATED GREASE SYSTEM . DEDICATED GRAY WATER SYSTEM _ _ _ DEDICATED WATER RECYCLE SYSTEM . DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER . FLOOR I AREA DRAIN _ _ INTERCEPTOR (INTERIOR) T . KITCHEN SINK 1 LAVATORY Z _ ROOF DRAIN . SHOWER STALL 2 SERVICE I MOP SINK _ TOILET 2 , URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES WATER PIPING 1 OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESV 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: 1 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. 4. CHECK ONE ONLY: OWNER V AGENT ❑ SIGNA E 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. To' l '/)!— PLUMBER'S NAME Troy Gilbert LICENSE # 25383 ?To' MP ❑ JP V CORPORATION ce# 4350 PARTNERSHIP ❑ # LLC ❑# COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave CITY S. Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX CELL 508-850-6955 EMAIL Katherine@Coastalphc.com