The URL can be used to link to this page

Home My WebLink AboutBLDP-21-001585 f4, • t3� L /4 I/19 L/kw/ ASO' Chl ck MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CI4 yn r,10,t n/ MA eeDATE 5"/7--202 c PERMIT# IJI"-Q I-C�( S JOBSITEADDRESS A P1Ccr.SFtNt c$ OWNERS NAME/5/ /9-4/ /4rso•r) OWNER ADDRESS 4/6 r/ SAN 7- S/ Tt(ao?)y/s-8699 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL ei PRINT CLEARLY NEW:0 RENOVATION:1C REPLACEMENT:0 PLANS SUBMITTED: YES 0 NCA' FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 B 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 SYSTEM _ DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY X 1� • ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET x' URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING X X OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESNO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY j OTHER TYPE OF INDEMNITY 0 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. CHECK ONE ONLY: OWNER❑ AGENT 0 SIGNATURE OF OWNER OR AGENT LU 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 Wth all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME LICENSE LICENSE# 3/ q 3 ' / SIGNATUREMP 0 JP I�p ? CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY AME o-Q.44/02£4 C',1#t1E or ADDRESS / r,TZ Gid�o �ctn C CITY /'Or�/ t� STATE ZIP 0.13717 TE4/1)397 sVC/ FAX CELL(/i/7�tiSf7-55/0/ EMAIL ROUGH PLUMBINGI INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES A.I/1 Ok 61i /A/A-ei Cf Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/25/20 PERMIT# BLDP-21-001585 rry JOBSITE ADDRESS 46 PLEASANT ST OWNERS NAME REILLY JAMES J P OWNER ADDRESS C/O J MCLELLAN P 0 BOX 372 SO EASTON,MA 02375 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YESD NO❑ FIXTURES I 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/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 1 1 ROOF DRAIN SHOWER STALL 1 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING 1 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 0 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. PLUMBERS NAME Andrew Cameron LICENSE 3t1643 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANDREW J CAMERON ADDRESS 1 FITZGIBBONS LN CITY ROCKLAND STATE MA ZIP 023701968 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT n n FEES$ PERMIT# PLAN REVIEW NOTES