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Home My WebLink AboutBLDP-22-003716 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 3 CITY YARMOUTH MA DATE 1/4/22 PERMIT# BLDP-22-003716 JOBSITE ADDRESS 14 LILY POND DR OWNER'S NAME Sue ellen Ford P OWNER ADDRESS SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATIONS,❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTIIRFS FLOORS-. RPM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND El 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 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 Andrew Leighton LICENSE L6130 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME ANDREW R LEIGHTON ADDRESS 20 Brewster Rd CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES .p MAs SACHUSET T S UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 'Mt } DATE 3 . 3 PERMIT %. CITY _.. _4_ 4131. _ -_... . ._— MA ,._I ^� 4 OWNER'S NAMME ,5 e fi en J t4c/ . vosslTE ADDRE � /� .�,'L� �� .J�- � � � Ao,_2�.. y�0r fFAX I OWNER ADDRESS . . RESIDENTIAL TYPE OR 1 OCCUPANCY TYPE COMA+ RCIAL EDUCATIONAL PRINT f CZ) RENOVATION:CLEARLY �� REPLACEMENT:I!!f PLANS SUBMITTED: YES��.< Ito ; } ' + 1 6 ' 7 j 8 ! �� k t� 12 I 13 _`\ FIXTURES 4. FLOOR- ! Bs ' 1 2 I 3 1 4 . 5 + 1 __ - - BATHTUB ;--- -- T _ CROSS CONNECTION i0N DEVICE _.__.____._.._-_ ---__ _ ._.._._.._---- - _ - ► DEDICATED SPECIAL WASTE SYSTEM . - ._.-- __..___._. __w_._-_DEDICATED GAS/OIL/SAND SYSTEM - _ _ --- - - ; ___ --_� = •_ DEDICATED GREASE SYSTEM _ �- -- - _ . _ __,_ __ -_ _' - ; - DEDICA DEDICATED GRAY WATER SYSTEM E ,--� _ __ - WATERRECYCLE SYS T E.�r` ____ _ - - - - --- -_..- --- ._ DEDICATED _. _ _ -__ _ -- - DISHWASHER __ - - . _ -- � DRINKING FOUNTAIN i______-*--- _.__ .__ �:� ;� ;� ---- FOOD DISPOSER � FLOOR/f1''SEA DRAIN i . Yant �. ��.�: ._... :��. 01111. anNUMMOMMINIlir - sr — 111• - -?' IN i ERCE'"TOR(llv'T�R1GR) I ___.: _ _ I�T C(�EN SINK - •-- -LAVATORY alIMIMINTIII._- _: ROOF DRAIN I----- _ .�._. -.- 1511 ' :: = - ` 111.11111 SHOWER STALL s �___.. __ . - •. __ - - - -�_--- -_ __ . ._ VICE MOP SINK s -- - -- � � • - __ - - SSR / ' 11111 TOILET.' - pownw _ .: URINAL _ ___ _ - WASHING NMACH'sNE CONNECTION r - . - - —-- WATr_R+iE ALL TYPES r ,.._ � _ WATER PIPING _ -_onor — i OTHER - ---- -----'----- --- ------------goripr - - : _ _ �- - iiir. tali �-�---- _ INSURANCE COVERAGE: the requirements of I�lGL Ch. 142. YES � NO ,,, I have a current liability insurance policy or its sub5tarlIiat equivalent which ED YES, PLEASE I ?iCA T E THE TYPE OF COVERAGE BY CHECKING- APPROPRIATE BOX BELOW IF YOU CHECKED � *t �/�},. �+ ; � �� ' INDEMNITY � = BOND`ABILITY INSURANCE POLICY ' ✓t. cER `.E O' 7 —^ .. �� OM Chapter� �of the ,°WIEcoverage requiredby rS INSURANCE WAIVER: i am aware that the licensee does not have the insurance MassachusettsR signature on this permit application waives this requirement.Genera! Laws, and that my � -- { CHECK ONE ONLY: 0 ER AGENT — f jicno SIGNATURE OF OWNER OR AG \17 r:, - sue - _ � . my that all of the detals and ikon I have submitted or entered regarding this aP p -- � p _,- _- with =- P- : ..-• . • son of it I nd that certifyperformed udder the permit issued for this app icatio 7 end 8ii plulT'I�III�work and installations Y�"" �� of'�2 General LEAS. �� ?vl ':ttsetts She Plumbing Cade and Char • PLUMBER'S ANDREW LEICHTON ;LICENSE rEli130-I~A ' ' GNATURE � �i ? !PARTNERSHIP! • '=` ;LLG �I CORPORATIO ` „-� 3 34G MP I r '-- JP ' COMPAN`! DAME' HALL OIL COMPANY INC. ADDRESS 1 435 RT 134 -- -_ :STATE ZIP 0 TEL -5O8-39$-383 i - CiT"ISOUTH DENNIS - - ...o.. .�- 1 CELL 5 EMAIL 4 halloilco7anyggrnail.com ____ :Y..�� _._, - :,-.