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Home My WebLink AboutBLDP-22-003219 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/7/21 PERMIT# BLDP-22-003219 tl JOBSITE ADDRESS 161 MATTAKESE RD OWNER'S NAME Jeff Dietz P OWNER ADDRESS 161 MATTAKESE RD WEST YARMOUTH,MA 02673 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL m PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTIIRFS Fl OORS RSM 1 2 3 4 5 6 , 7 8 9 10 11 12 _13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND 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 Troy Gilbert LICENSE 18573 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL I I EMAIL lisa@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 0 FEES$ PERMIT# PLAN REVIEW NOTES -"` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _.:lib�� CITY 1 Yarmouth ,i MA DATE F12/01/2021 4 PERMIT # 3 l 1 JOBSITE ADDRESS 1 Mattakese Road OWNER'S NAME- Jeff Dietz -- , OWNER ADDRESS E10 Orchard Park Drive- Reading, MA 01867 _ TELT- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL il PRINT CLEARLY NEW: RENOVATION: El REPLACEMENT: J PLANS SUBMITTED: YES El NOD FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 _BATHTUB _ CROSS CONNECTION DEVICE _ , DEDICATED SPECIAL WASTE SYSTEM t t- . , - 4 __, , DEDICATED GAS/OIL/SAND SYSTEM ►--- DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM __ DISHWASHER --- DRINKING FOUNTAIN _ FOOD DISPOSER Ilow FLOOR !AREA DRAIN Fes. INTERCEPTOR (INTERIOR) 4Y KITCHEN SINK LAVATORY W. Willi : :: �. . ROOF DRAIN SHOWER STALL SERVICE / MOP SINK ii _____ TOILET 3, i t N ,, URINAL WASHING MACHINE CONNECTION ftr, „gly .44 WATER HEATER ALL TYPES 1 1.. -4 -- --f - - . , WATER PIPING - . OTHER — I Luallelegt -aiNNIIII•at.. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES L71 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 L 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 Pertinente' in� provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r- G%�{J/'?,$ PLUMBER'S NAME Troy Gilbert LICENSE # 13573 SIGNATURE MP i JP ri CORPORATION L_ # PARTNERSHIP„„ # jLLCIj# 14350 COMPANY NAMEI Coastal Mechanical 1 ADDRESS , 21 L Fruean Ave CITY_ South Yarmouth STATE MA ZIP 02664 ' TEL 508-737-8747 FAX l CELL 508$50-6955 EMAIL lira( coastalphc.com 1