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Home My WebLink AboutBLDP-21-005636 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u,, ,: CITY YARMOUTH MA DATE 3/30121 PERMIT# BLDP-21-005636 L "yl `U JOBSITE ADDRESS 39 CHANNEL POINT DR OWNER'S NAME KENEFICK JOAN E TR P OWNER ADDRESS C/O THE STORAGE SHED;ATTN:FRANK 275 BAILEY ST CANTON,MA 02021 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El 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 2 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 penult 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 Michael Mcbride LICENSE f6681 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES 4ad MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ii l/ ii CITY 1A.1 • l r. ' i�L1 G �SL �' ��MA DATE Z PERMIT JOBSITE ADDRESS `I ( 4 Q/1.1 �"� y�C�, AU, 12-. • OWNER'S NAME 6)(1 �1 /o-E'� e , 7 OWNER ADDRESS 2 ,, �,y 5�,�7 / TEL / 1CS, YFAX TYPE OR OCCUPANCY TYPE -rd-C�MMER L❑ Z C�i6ucATIONAL D RESIDENTIAL PRINT CLEARLY NEW:❑, RENOVATION:❑ REPLACEMENT:® p -C t c 11vm°5 PLANS SUBMI I I ED: YES ❑ NO❑ FIXTURES 7. FLOOR-+ BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE f - DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY • ROOF DRAIN SHOWER STALL 2 SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ,t,)/, , �1 WATER PIPING OTHER I INSURANCE COVERAGE: ---- I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES E NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 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 theMassachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ 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 Pertine t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME \�\ +,�? v L GlL'F! \ Q- .� � LICENSE# � SIGNATURE MP JP CORPORATION ❑# P()PE PARTNERSHIP❑.# LLC❑# COMPANY NAAt)E ,V\ ( f ir.C--0 t— ( I- ADDRESS (2 L/ C 3 r( CITY - I Cc / JV) 0 c' , STATE L A.., ZIP Ci 12 Cr 7 3 C' FAX TEL CELL EMAIL 1-1 - C 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