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Home My WebLink AboutBLDP-22-003970 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK , CITY YARMOUTH MA DATE 1/18/22 PERMIT# BLOP-22-003970 JOBSITE ADDRESS 715 ROUTE 6A OWNER'S NAME APANDIDA LLC P OWNER ADDRESS C/0 ROYAL II RESTAURANT&GRILLE 715 ROUTE 6A YARMOUTH PORT,MA TEL 02675 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATIONS,0 REPLACEMENT'.❑ PLANS SUBMITTED: YES El NO❑ FIXTURES 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 Richard Olsen LICENSE 10335 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD P OLSEN ADDRESS PO BOX 2026 CITY DENNIS STATE MA ZIP 026385026 TEL FAX CELL EMAIL office@olsenplumbing.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ID ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK it CITY It . mull.;.►ah .?b r'`C I MA DATE I ti UL PERMIT # 2-1 - 3'i -)4 JOBSITE ADDRESS I 1 1 ,mc1,,� S} LA 1 OWNER'S NAMEr • 1.1C --ri . i P I OWNER ADDRESS TELL 'FAX! TYPE OR OCCUPANCY TYPE COMMERCIAL 1'4 EDUCATIONAL I i RESIDENTIAL rj PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: `� --1 PLANS SUBMITTED: YES NO I FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB .___ _I .__ 14 _ I i. !i ' CROSS CONNECTION DEVICE -- -- -- DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM m" k , _ _ -- _ DEDICATED GREASE SYSTEM -�-- - s DEDICATED GRAY WATER SYSTEM L E DEDICATED WATER RECYCLE SYSTEM "" ^i DISHWASHER �� DRINKING FOUNTAIN _...._ FOOD DISPOSER --- FLOOR/AREA DRAIN . - _r�.....-._ INTERCEPTOR (INTERIOR) KITCHEN SINK _ - — --- LAVATORY . ROOF DRAIN =___ SHOWER STALL _-_.-_.. _____ _ _ _ SERVICE / MOP SINK TOILET _ ___ URINAL _. WASHING MACHINE CONNECTION ___ — WATER HEATER ALL TYPES = _. R WATER PIPING _... _ OTHER I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ;7 NO a IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v OTHER TYPE OF INDEMNITY Li BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required byChapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. p CHECK ONE ONLY: OWNER l AGENT j 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 a feo th -bs f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co c PPe . �'ovisio he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �' _ /w PLUMBER'S NAME Richard Olsen LICENSE # 1 M10335 / , 1 ATURE MP i JP CORPORATION i # 2166 PARTNERSHIP i#I I 1 LLC # COMPANY NAME Olsen Plumbing & Heating d [ ADDRESS P.O. Box 2026. 357 Hokum RockRoa I CITY Dennis STATE L MA ZIP02638 1TEL 508.385-5290 µ FAX ` 508-385-6963 CELL _ __._ ` EMAIL ° O�c-r Ce lea e t PL 0 m I JJC r