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Home My WebLink AboutBLDP-21-006900 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11) CITY YARMOUTH MA DATE 5/27/21 PERMIT# BLDP-21-006900 JOBSITE ADDRESS 5 CEDAR ST OWNERS NAME adam tate P OWNER ADDRESS MA01803 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 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/OIUSAND 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 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❑ 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME Herbert Healis LICENSE 30177 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME IHERBERT M HEALIS I ADDRESS 78 STUDLEY RD CITY IS YARMOUTH STATE MA ZIP 026642906 TEL FAX CELL I EMAIL hhealis@yahoo.com v ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes \o THIS APPLICATION SERVE AS THE PERMIT El El FEES$ PERMIT# PLAN REVIEW NOTES is:' A i / ii . . a 4: . i _ i. t_ - _ --- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK b4.7) CITY YaICI ouch__._-- MA DATE 5/26/21 PERMIT # ..D?- 2l—°° b`i a 0Yam, -1 JOBSITE ADDRESS 5 Cedar St OWNER'S NAME Tate POWNER ADDRESS _ Same _ -- TEL FAXTYPE OR OCCUPANCY TYPE COMMERCIAL 111 EDUCATIONAL ❑ RESIDENTIAL id PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:0 PLANS SUBMITTED: YES El NO KI FIXTURES Z FLOOR—) BSM 1 2 3 4 6 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE �__ �, -.-� DEDICATED SPECIAL WASTE SYSTEM — J — DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ^ - DISHWASHER DRINKING FOUNTAIN � __ FOOD DISPOSER --- .....___ .-_ __._...._- FLOOR 1 AREA DRAIN __-_ _ __ INTERCEPTOR(INTERIOR) KITCHEN SINK rLAVATORY `---- _. . ROOF DRAIN _ ____ SHOWER STALL __ SERVICE i MOP SINK — TOILET . _.......—_ URINAL WASHING MACHINE CONNECTION __.�. - ---v---__ _-_._ _. .____ _ , WATER HEATER ALL TYPES 1 — — ~ WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG! Ch. 142. YES J NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE OF INDEMNITY ❑ 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 I I _ _ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regar_ding 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. y'/am /e.Ce(' PLUMBER'S NAMEHerb Heals LICENSE # 20177 - -- SIGNATURE f MP ❑ JP [ CORPORATION El # PARTNERSHIP (1 # LLC ❑ # COMPANY NAME _ ADDRESS 78 Studley Rd CITY Yarmorth — — _ STATE Ma ZIP Q2664 TEL FAX CELL 508 776 5495 EMAIL hhealis@yahoo.com -