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HomeMy WebLinkAboutBLDP-21-003311 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ',rcw CITY YARMOUTH MA DATE 12/10/20 PERMIT# BLDP-21-003311 I3 JOBSITE ADDRESS 6 SOUTH WEST DR OWNER'S NAME HILL LIZETTE P OWNER ADDRESS HILL CHRISTOPHER 26 SHAWMUT AVENUE EXT WAYLAND,MA 01778-4814 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES FLOORS—r BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 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❑ 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 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 William Woods LICENSE 111887 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM T WOODS ADDRESS 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 Yes No THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES MAP : P.qgce( ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . 1:Firk==� .>,�--� pp MA DATE J . /1-r �` PERMIT# &PP'�1-1�` 3!/ - t3 - -� CITY L1 ✓� _.-�._..�1 .'. lam! 1 /E'�' n OWNER'S NAME JOBSITE ADDRESS a41.-Z 1 \ p OWNER ADDRESS _ - -cam j TEL �---- _____ —� IFAX , - - TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL -1 RESIDENTIAL E----- PRINT PLANS SUBMITTED: YES ® NO© CLEARLY NEW: ® RENOVATION: ❑ REPLACEMENT: FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 13 14 BATHTUB 1L__J=,E_ .J1..__ i__:._11._ -- 1_...11:_.`.I1-__IL - _AL-_,a,.�_.�.i ____i t CROSS CONNECTION DEVICE 'L,. 1_____j _ I 1( 1 1. � j.,,•._-. i._�.., 1_ k DEDICATED SPECIAL WASTE SYSTEM [a•�_,�C �,��.�-.__�i -.� �-T - -� _ 3- •-.Cr - DEDICATED GAS/OIL/SAND SYSTEM 1,,, . . '`1 jI ..A I z1_ _ 1 I - --UI it____,L�s: J. ` DEDICATED GREASE SYSTEM i ,i a; _. - ��_-.. .�_ ��i� � _--• - _ DEDICATED GRAY WATER SYSTEM L.- .:r-�11.., _-- -�_— sl-r = . - --Z-�-�-�1I� 1 DEDICATED WATER RECYCLE SYSTEM (-- i j L...�_J =-,� - . i.I . - - L-. --�1=-," ,,,._1 DISHWASHER L ', "_ DRINKING FOUNTAIN 1 I A IL__11- =I —J=1— ! FOOD DISPOSER 1 �1 - 1! I = _ J ___-1L,,. , I_,.,„,,d1_. 1_t_. FLOOR /AREA DRAIN 1 _ 0, _ L 11 _ L. _ . ALSE,_____ 1I C« « ..r..3_ - INTERCEPTOR (INTERIOR) ( 11 —iI., it _ a,,_,I _-•- ,.. ` 1 -.� j1]=1_ 1,___".`v` 1 . KITCHEN SINK -R-•--- r_�-W- _ --- -"�. _" .'.�� LAVATORY 1�MI _�_Ai._ _iI I __-___-- i{ �. R =�-�r.3 1i ROOF DRAIN _. '---�-... .�'.. i� ,�_T SHOWER STALL j _S1 i _ I _ I ,_,. . '—'1 1L-o- �-=,_t j1 ��._-_7��.ac��.�� l�+e+� '± a-�I..---a ...�L�-araa�-.-,� � ���.s:r� _3�n er.v.��. 7�.��.=.�1 SERVICE / MOP SINK L ,,. 1., ;_..;. L:., .� 1.0 ,_...,1!__,J+ 1 i.,_A =- 1... L„,11 ,.... TOILET +-11_ --._ . JL [L .,.,, ^.. . :1____,.:- I' —�. 11 URINAL �..,}---31.,».�._._t(- _II --n(- ----.J!.,,�._ AL. _'�1 L �.,,:...,.�. L.�...--...i!..., d..... a WASHING MACHINE CONNECTION }' ,,,,,.,� 1_ _..,_.. r,ji�- �_I_. 1._s- wi - i' 1 __. Ls-��n.xl__,� [ 1.[__.�ll,�"..`,.z-' WATER HEATER ALL TYPES WATER PIPING J I�h' L- ._., S I_M_ 1 i _ 3 � r_ ;L..i=L_.1 �_i i £i a...11,. . ...._._j_�ji OTHER ;l_ 1 L..�,.._S. L... 1__: L��.__I,,�:__I�.._ __ . ..�. L__ -�I_r�=-J _ II II, ..._y-�. v I -1 __,-o• ..—o......,�.._:��-S/.-J.""---'-�:c �c Y I �.l,_-,.�41� M� � � 4+ems�-�L + �_�..• ...ri.� � � ��.�.�C•�I...-rt=-� 11 9 i loa..v.�. —_ _�. �. —a� _ c,,.,ate ' 1_.--;, .._.w-+,—_ INSURANCE COVERAGE: ''1, • I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ❑ NO ❑ ,-,,. 5-' g I7 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOWLA- 2 ,1 LIABILITY INSURANCE POLICY D OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b Gbdpiter142,of the K i i v aN T Massachusetts General Laws, and that my signature on this permit application waives this requirement. By _ �__ _-- • • CHECK ONE ONLY: OWNER ❑ AGENT Lj 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 p •sion he Massachusetts State Plumb1 g Code an' Chapter 1 • of the General Laws. - . 4,4 iV PLUMBER' -NAME, _ . ..4 `C ei. .II ( . _ _ . LICENSE# liaad SIGNATURE • MP JP❑ CORPORATION PARTNERSHIP[LP _ , I LLC 0# .........j '' � �/ ADDRESS r V �G E -- Ci - I 6 .5-4k- .. - . COMPANY NAM i CITY 4 V A STATE wanr I P �.. ,A7:...1 TEL g 6c4 ?ju - ' I j FAX CELL 4,, 7. 735:___1 EMAIL - A?'` CO - GD r ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES R i p Zi!6 1 Z02-o Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE:S PERMIT# PLAN REVIEW NOTES fr $.M 'aJw s1$ue'