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Home My WebLink AboutBLDP-21-006460 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH ] MA DATE 5/7/21 PERMIT# BLDP-21-006460 JOBSITE ADDRESS 9 RUNE STONE RD OWNER'S NAME Matthew Regan OWNER ADDRESS 9 RUNE STONE RD SOUTH YARMOUTH,MA 02664 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 1 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL - SERVICE/MOP SINK 1 TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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❑ 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 michael pierce LICENSE 3i1718 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME ADDRESS 4 kaycees way CITY west yarmouth STATE IMA 1 ZIP 02673 TEL FAX CELL 7 EMAIL mapierce774@gmail.com 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -t- s- 1 l a"� CITY/TOWN aI C+S °' `1 MA DATE (/ /Z/Z I PERMIT# P.L 0 P-1 t"out (1"JOBSITE ADDRESS CI K.vi C 3 --6 i'v OWNER'S NAME.f P.M' I., POWNER ADDRESS _ _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL L ••'' PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES -1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 t2 13 14 I BATHTUB CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN I INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN 1 SHOWER STALL . SERVICE/MOP SINK j TOILET 1 URINAL • WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES I _ WATER P4PING I _ OTHER INSURANCE COVERAGE: I have a current IiabilitYinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L0 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY la" OTHER TYPE CF 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 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. L PLUMBER'S NAME r7�iiG fJ/f-' C LICENSE# �� /S SIGNATURE MP❑ JP 2/�� CORPORATION ❑# PARTNERSHIP❑# LLC❑# COMPANY NAMEI ie-,CC 00)�11I 1 kC/)0uC,4(.0, ADDRESS /<c;`10E( S. L (,,�j • CITY ��'( 6� �� G. r- 1i'4GLi`)-V 1 STATE'�(+`t ZIP 'flak .7 TEL FAX_ CELL 7 7 C( 7 J- 3- 34a 1 EMAIL71 c'Ce P/G' bih fr/t.,5C 4-0(.•e ( 6Pie , Leo ill ---J