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Home My WebLink AboutBLDP-22-003585 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLDP-22-003585 JOBSITE ADDRESS 149 STATION AVE OWNERS NAME Jessica croker P OWNER ADDRESS 149 STATION AVE SOUTH YARMOUTH,MA 02664-0892 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO FIXTURFS FLOORS—, RSM 1 9 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❑ 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 Richard Olsen LICENSE 1/3335 SIGNATURE MP ❑ 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 0 0 FEES$ PERMIT# PLAN REVIEW NOTES i ' f V E til .SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 CITY In M• qc i (nQOCy) MA DATE PERMIT # �� • 20toBSITE 'DDRESS I go 1Qi7 avenue I OWNER'S NAME[ ss 1 C,Cw CrO1L r BU LDIN� ER By: ART R l DRESS 1— __- _.W __ TELM6-&01: y=itoC ,FAX TYPE OR OCCUPANCY TYPE COMMERCIAL I_i EDUCATIONAL E RESIDENTIAL PRINT REPLACEMENT: PLANS SUBMITTED: YES NO CLEARLY NEW: :_ RENOVATION: [,� FIXTURES -1 FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM __ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ______ DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN , INTERCEPTOR (INTERIOR) KITCHEN SINK ....._ ..-- ...�� ._.___..... _. LAVATORY — — ROOF DRAIN ____ SHOWER STALL SERVICE/ MOP SINK TOILET URINAL W WASHING MACHINE CONNECTION I .! ' WATER HEATER ALL TYPES WATER PIPING _ OTHER --- —- - ___ _._,. 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 i ,1 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 AGENT 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' e with r'Peliinent ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �" PLUMBER'S NAME RICHARD OLSEN 'LICENSE # [ ic3 SIGNATURE MP IP CORPORATIONS# 2166 PARTNERSHIP - J # LLC # COMPANY NAME! OLSEN PLUMBING & HEATING �� ADDRESS 1357 HOKUM ROCK ROAD CITY DENNIS STATE MA ZIP 02638 ` TEL 1508-385-5290 FAX 508-385-6963 CELL EMAIL 1