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Home My WebLink AboutBLDP-22-003597 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Lk.;;Tle- CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLDP-22-003597 JOBSITE ADDRESS 9 ARCHIE RD OWNER'S NAME Elizabeth Sasseen P OWNER ADDRESS TEL 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. 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 Lorne Jussila LICENSE r971 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME LORNE B JUSSILA ADDRESS PO BOX 131 CITY WEST HARWICH STATE MA ZIP 026710131 TEL FAX CELL EMAIL lornejussila@hotmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES S sp, p d 4,..._ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK --�— CITY (gAlitv ' `J MA DATE 1 iT� �3- � 1 PERMIT# 3 j 1� C A R;SS ('C k( c-,67 OWNER'S NAME(l rZciG)?� h .Jry c.Vell TEY�S -6(6, ,'(1 $/FAX BU ING L�1N��FrRMENT .SS �Gj[iY12- By TYPE OR • ' '- 1 PE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: [ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 2i. FIXTURES 7. FLOOR-# BSMJM 1 2 3 4 5 6 7 B 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 SYSTEM 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 % I 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. YES24 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY CS 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 l' 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 certify that all of the details and information I have submitted or entered regarding this application are true and accurate tote best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance witll Peftinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t � .<• % 44/ PLUMBER'SNAMEJC)rd2 J7j,5iIcy LICENSE# 5/5-1/ . // /7 SIGNATURE MP❑ JPX CORPORATION❑# PARTNERSHIPgg ❑# [ LLC(�# COMPANY NAME lr � guryll),, IM-14-4'4) ADDRESS iJ /`gile An n CITY iig`r LU;(v~ STATE /%/.,(I ZIP (3�,- y S TEL FAX CELLS/OS`77�- 3" 7/ 3 EMAIL O( 2/ 1---/ 1 __�,, r, / CC-IV / (•