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Home My WebLink AboutBLDP-21-004300 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/30/21 PERMIT# BLDP-21-004300 -_1- JOBSITE ADDRESS 308 ROUTE 6A OWNER'S NAME COSTELLO ROSALIND P OWNER ADDRESS COSTELLO MARSHA A 308 ROUTE 6A YARMOUTH PORT,MA 02675 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION / TZ 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 requ rement. 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 William Woods LICENSE#1887 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM T WOODS AC DRESS PO BOX 702 CITY (W BARNSTABLE STATE MA ZIP 026680702 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Fw✓ U'f.N+ o 21s(zf Yes No THIS APPLICATION SERVE AS THE PERMIT G FS FEES$ PERMIT H PLAN REVIEW NOTES EC %c0 flAP .' PAR MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,n'= ' i ' I MA DATE PERMIT# / _t0 wlir=Y CITY Oho .may•'=':+` JOBSITE ADDRESS 30! 10-1 4 ' (971- _ 1 OWNER'S NAME,/C/Mi p _ OWNER ADDRESS (� TEL.: FAX ___II__--- TYPE OR OCCUPANCY TYPE COMMERCIAL J EDUC TIONAL -I RESIDENTIAL IR PRINT PLANS SUBMITTED: YES ® NO CLEARLY NEW: ( RENOVATION:❑ REPLACEMENT: FIXTURES 1 FLOOR-I BSM 1 2 :3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 _ L E • �i L .11.1.111111111 CROSS CONNECTION DEVICE ! , _ _ _ -L _ �. f b - - .MAM__ . DEDICATED SPECIAL WASTE SYSTEM z�ti`I _,_„_ _ - _— -- M L- _- , r DEDICATED GAS/OIL/SAND SYSTEM ..�___-..I ....- ' -.- _--1 jyr---2--___ILL__ L JL ��-_---- .. DEDICATED GREASE SYSTEM 1�__-� -�_-:i_. - ---__ 1_,-,' __' ii - DEDICA DEDICATED GRAY WA T Eft SYSTEM 7-11 I A T-- cKI 'I _ _ _ -Tii -- -- _ - _ . — - �-.�.._, . . DEDICATED WATER RECYCLE SYSTEM '. AIM . -. 1�... _II --•..- 1 . __. , 1 ..,__i - - DISHWASHER -- - 1;.,,.��'1—..:.- '- .._-L._..,_e i► - . 'I_- _•A.-- —,'M =-.� - ,_____, DRINKING FOUNTAIN ; ,` FOOD DISPOSER S .____;,_I _ I . . "`__' I ..,.J FLOOR /AREA DRAIN - - I, ., -___ .1 . 'IC---.- ----_-___JI....... . i _ ___i _ _ _It' .. _L._ ..----_ INTERCEPTOR (INTERIOR) __ _ - r.--- - s J j =1 . - - l ` "_— _Ali .. . KITCHEN SINK - .i - I- - ' ! __:. 4'.�.__,L__ 4 - - - ' - . ;I-14 I L� . 11_ —4 I. =L_�!I2[ram - - �— I! LAVATORY A �_ — j ROOF DRAIN ,� --- - I�,.�......., 1��.�- 1 _i..__,—i SHOWER STALL -- - SERVICE / MOP SINK ' ` J' 'I I '�1._..11.�_--`_' L.. 1` ,.. I�— TOILET TTC L- _'L _ - _I ____ __ _._: !:_,.a .'L� —,n'I....__ _jI . [_�._---_.,.t URINAL - I - - ,- �� .� WASHING MACHINE CONNECTION 1«� '<<_�� _ - - _ ____4L_ __, WATER HEATER ALL TYPES L:o. ...-.�.: -.-i._.r.._..�- I�..._IL. ;.�--_- --'{ _ . ' I_-..,�_-.... .. �_ s _ _IL Jf I �.�9L. J i.._ _ L ..�II___.,�. 1..,.._._. .....;...J WATER PIPING ---�--9 �--� �'-��i "`"�� OTHER A _ -_ -_ I - 1I _ 1I _11_ - -- -� J - - - . - -.1____ ` -_ j ._i.-'�!'�'',_. _:�. .�_ s,i ]MlIM. = - --- IMM�III .a�n. Q{r.._ )L� J J...�,_J l --._-.J�..._....,�,_ __ � �. .��_.�t_�. .....�...�._Y.... INSURANCE COVERAGE: - } liability insurance policyor its substantial equivalent which meets the requirements of MGL Ch. 142.'1'E N0 ❑ , - �, Ihaveacurrentl ty � it= YOU CHECKED Y:ES, PLEASE !�`!D!CATE THE _ E OF COVERAGE BY CHECKING THE APP ROPRIATE BOX BELOWi------- :r-A `J LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND 1-1 . i ° IAN 21 21121 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required SIbilltfritStAirkiEii-1\-A.ENI Massachusetts General Laws, and that my signature on this permit application waives this requirement. BY. ----- CHECK ONE ONLY: OWNER El AGENT Ej 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 Pertinen pro,ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /`,�.r[ 1`� LICENSE# IL142(3:61„is. _1 SIGNATURE- PLUMBER'S NAME � 1 --- CORPORATION _PARTNERSHIPa t _ __- A LLCLI#MP JP � COMPANY NAME ,4 4If,i ADDRESSPô py rav-- - . - -- CITY fflifi, i • l STATE /V7 I ZIP j 4.6.:____ J TEL 572 jigral g _- -- EMAIL idcT /� � � �_.-,..�_.�FAX CELLJEA - 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 rr ta$P 1' a•••• w"1 • I •