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Home My WebLink AboutBLDP-21-006857 #11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/25/21 i` PERMIT# BLDP-21-006857 CV it JOBSITE ADDRESS 11 &15 NEW HAMPSHIRE AVE OWNER'S NAME DONOHOE PETER P TRS P OWNER ADDRESS DONOHOE PHILOMENA 427 WASHINGTON ST CANTON,MA 02021 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 1 CROSS CONNECTION DEVICE 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 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 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. PLUMBER'S NAME Ryan White LICENSE 1' 068 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RYAN L WHITE ADDRESS 19 SKIPPERS DR CITY Harwich STATE MA ZIP 026453122 TEL FAX CELL EMAIL rwhite1011@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT El ❑ FEES$ PERMIT# PLAN REVIEW NOTES iv 4P , p6 Kc_e : 1 ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK kji' CITY "lettnnoJ MA DATE 5'« JZ4 PERMITS aLD P 7.1-00OTS-1 JOBSITE ADDRESS 11 A)(,..d 1 :re / -QC• OWNER'S NAME C c.1 z POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Ld" PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES[] NO❑ FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSANO SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I - DRINKING FOUNTAIN - FOOD DISPOSER FLOOR/AREA DRAIN • INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY -ROOF DRAIN SHOWER STALL 1 SERVICE 1 MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: — / I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES®/NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW �v// LIABIl iTY INSURANCE POLICY Cf OTHER TYPE OF INDEMNITY ❑ BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requited by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT 1 hereby mealy lhaf all of the delais and info naion I have submitted or entered regarding Ibis application are true and accurate to Ire best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application veil be in com with al Pertinent provision of Me Massadnuerels Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Z,,Lx,,,l LICENSE#ictia2K SICNA MP 91 JP❑ CORPORATION❑# PARTNERSHIP❑# tic❑# COMPANY NAME Lk, ( P f if ADDRESS Po & c(Z':5— CITY I hL, STATE A' 211) d Zk°Y-S- TEL JO fi �Co 7 5 7.5 FAX CELL EMAIL It 1LAL�'C (U(1�y,.,r. .- 6.-v�