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Home My WebLink AboutBLDP-22-00142 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK :,), CITY YARMOUTH MA DATE 9113/21 PERMIT# BLDP-22-001442 JOBSITE ADDRESS 46 LOOKOUT RD OWNERS NAME Margaret Gorton P OWNER ADDRESS YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES t FLOORS—) RSM 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 1 DRINKING FOUNTAIN FOOD DISPOSER • FLOOR/AREA DRAIN • INTERCEPTOR(INTERIOR) • KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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 D 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 El OWNERS 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 as 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 at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME Thomas Bulger LICENSE 10099 SIGNATURE MP El JR El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME THOMASP BULGER ADDRESS 10 PIPER ST CITY IQUINCY I STATE MA ZIP 021696428 TEL FAX I CELL EMAIL tombulger2@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El 0 FEES$ PERMIT PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Rw��lrjr�s — ' ::_-1._.- "�....... C (a.ir� c1 r 1 MA DATE0- Zd Z' PERMIT# 22- 144 L SE V13 24,1I0BSITE ADDRESS 2 LC1C7lt_CO L d OWNER'S NAME miQJgrAv*,T 0%76( OWNER ADDRESS TEL FAX B ILDI .. DEPARTMENT BY.- IYP-P OR-----i-oc CI IPA NCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL g PRINT CLEARLY NEW:El RENOVATION:,-- REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES Z 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I DRINKING FOUNTAIN l FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) v KITCHEN SINK I LAVATORY 1 • ROOF DRAIN SHOWER STALL SERVICE/MOP SINK 1 TOILET I URINAL — . j WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES WATER PIPING I ' OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES% NO 0 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. � CHECK ONE ONLY: OWNER 0 AGENT ❑ Z_ 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' ' rice with all P inent ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME k .k O v`A a5 ?vle{`''� LICENSE# 1 d O SIGNATURE MP% JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME 9..)V 1gc-/- PL- ADDRESS to P c p 6,- S CITY GI`) t lV C f STATE C ZIP CT t (0 I TEL (01 1- /O 1) .—7 3° FAX CELL EMAIL 10 W,_a JLL ' 2 ck G1M i t 'Co M- 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 i