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Home My WebLink AboutBLDP-22-000178 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7/12/21 PERMIT# BLDP-22-000178 JOBSITE ADDRESS 452 ROUTE 28 OWNER'S NAME T&C Holdings P OWNER ADDRESS 452 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS • 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 David Houde LICENSE t6673 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MCDONNELL MECHANICAL ADDRESS 79, School Street SFRVICFS INC CITY West Dennis STATE MA ZIP 026702445 TEL 5083940005 FAX CELL 5082463152 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .1— � f _.1_I < ' CITY ( r� � MA DATE -2//0 I •.)- / PERMIT#j L O P Z 2 oo(;1 -)y LLJ f > i o a JOBSITE ADDRESS ��-�Pq iy 57 . %t 110i�cam, I OWNER'S NAME C ih� r LIU .�-a DE OWNER ADDRESS TEL FAX 0iirPEIDF OCCUPANCY TYPE COMMERCIAL CQ----- EDUCATIONAL ❑ RESIDENTIAL❑ LU —1P R114'T 1 ce -___QLE R4Y NEW: ❑ RENOVATION: ❑ REPLACEMENT:2.---- PLANS SUBMITTED: YES E NO❑ 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 - , DEDICATED GAS/OILISAND SYSTEM - DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM - DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN J - FOOD DISPOSER - FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) , KITCHEN SINK LAVATORY ROOF DRAIN { SHOWER STALL - SERVICE/MOP SINK { TOILET - URINAL i WASHING MACHINE CONNECTION 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 ❑ IF YOU CHECKED YES, PLEASE INDICATE THE YPE 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 the i Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I I hereby certify that all of the details and information I have submitted or entered regarding this application are tru 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 lian e with all Pe ' ent pprr vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. vh._. .7"--77%'� PLUMBERS NAME 1) L.--, q' '/c)L.-; LICENSE# /6 6)I SIGNATURE MP 1✓J JP0-- CORPORATION ❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME t-- ��-<-l7� ADDRESS 70/0 7`�c' 4.fi2?t.----4li7/'C CITY //a Cw C 4 STATC/Y- ZIP (7i r TEL S O -.)-4 - G �((y • FAX CELL EMAIL t!Jct vi cI Ho(--,./(_, 6 ® (y-r, c>i 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