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Home My WebLink AboutBLDP-21-004580 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 2/12/21 PERMIT# BLDP-21-004580 ..)2. JOBSITE ADDRESS 29 SUMMER ST OWNER'S NAME HUGHES JOANN P OWNER ADDRESS C/O TEAGUE MATTHEW&LINDSEY 1492 HYANNIS-BARNSTABLE RD TEL BARNSTABLE,MA 02630 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 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING 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❑ 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 16068 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Ryan L White ADDRESS PO Box 425 CITY (Harwich 1 STATE MA ZIP 026450425 TEL FAX 1 I CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMITS PLAN REVIEW NOTES g ). MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK V-1i.---7- CITY v f Ma LA MA DATE 2"f- Z( PERMIT#Vl--`�U c C'(-'' i - ,IOSSITE ADDRESS ZT £w41MICr St*(.5 Ira r e) OWNER'S NAME Ackley t c. ley POWNER ADDRESS_ _ \ // TEL FAX TYPE OR OCCUPY TYPE COMMERCIAL ElEDUCATIONAL ElRESIDENTIAL PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR-4 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GASIOII JSAND SYSTEM DEDICATED GREASE SYSTEM . DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN . INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _ } _ ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET i URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES f WATER PIPING j 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 TYPE Of COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POt CY I/ 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby cerlify that ad of the details and information I have sub mated or entered regarding this application are bue and accurate to the best of my knowledge and that all plumbing work and installabons performed under the pemw Issued for this application will be in corn Pertinent provision of the Massachusetts Stale Pkaebing Code and Chapter 142 of the General Laws. PLUMBERS NAME I•te"L ale„ LICENSE# Ale4 g SIGNATURE MP[t JP❑ A CORPORATION El# PARTNERSHIP El# LLc El# COMPANY NAME •t 1 4- ADDRESS PO 4 K qZ s CITY (4 -w.cka. STATE MA' ZIP 0ZU u(s TEL So & 2 (4 73 7$ _ FAX CELL EMAIL Litt..te lattg ,:t