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Home My WebLink AboutBLDP-22-004103 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK —ems, CITY YARMOUTH MA DATE 1/25/22 PERMIT# BLDP-22-004103 JOBSITE ADDRESS 210 STATION AVE OWNER'S NAME DENNIS YARMTH REGIONAL OWNER ADDRESS (STATION AVENUE SOUTH YARMOUTH,MA 02664 St,MUVL I TEL P TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El 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 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 1 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 Troy Gilbert LICENSE 1A573 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 I TEL FAX CELL EMAIL lisa@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ 0 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k:� r CITY South Yarmouth MA DATE 01/19/2022 PERMIT # L L- tit o 3 e.a 4 ..,_ 1.4w JOBSITE ADDRESS 210 Station Ave OWNER'S NAME Dennis Yarmouth Regional School POWNER ADDRESS 296 Station Ave - South Yarmouth, MA 02664 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li..j EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: 0 PLANS SUBMITTED: YES [] NO FIXTURES -1 FLOOR--► !El! 3 !BEI5 E 7 8 9 10 11 12 13 14 BATHTUB I 1 CROSS CONNECTION DEVICE 1 � ®i �il�AM illiallt DEDICATED SPECIAL WASTE SYSTEM MOM ME ill11111111111111111 1II1 DEDICATED GAS/OIL/SAND SYSTEM 111111 Fatill111.1111111111111111111111111111111Mr —11 IF _I DEDICATED GREASE SYSTEM 111111111.11111111111.111111.111111111111111111111111111.111111111111.111.1.111 DEDICATED GRAY WATER SYSTEM imumigigiumilmiummormum nip No EN MIMI DEDICATED WATER RECYCLE SYSTEM Jr M11 MIN Mill MIN MINI Mill MIEN III.MIIIM1 DISHWASHER MIMI ! M �.F D- I IMFOOD DISPOSER -into,.. ii iiiiiiiii, no= arnii, LI FLOOR/AREA DRAIN 1111111.1111111111111111 11111110111M1111111111111111 11111111111111 MIN MINI MIR Mill INTERCEPTOR (INTERIOR) 1111111111111111111111111111111111111 _ IIIIIIIIIIIIIIIIIIIIIIIIFIIIIIIIIIIIIIIIIIIIIIIIIII KITCHEN SINK I__iiiiiiiiiiii iiiiiiiiiiiiiirmi LAVATORY 111111 Millarnall111.11111111 1 M Mill NMI NM CONNECTIONSHOWER STALL NE 1111111 MI mom NE MEM ii. TOILET 1111111111111•01 IIIII Milli 11111111111111111111111111111110111111111111111111 _ _ "Ill WASHING MACHINE 1111111111111II=II 1111111111111l1=I1111111H I WATER HEATER ALL TYPES gm um TM—Imimp '1 MINI WATER PIPING Ip!R OTHER 1 Ig!ii! IIPP!mag-P iiimit.ina...,--1111010milaii L _ I... I 11111111=1 11f 1111111111I1111111111111111II111111I11111I11111111[ . 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 INS JRANCE POLICY U 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 Lij AGENT u 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. / t ./J�.2A PLUMBER'S NAME [Troy Gilbert LICENSE # 13573 SIGNATURE MP Li JP Li CORPORATION Li#- PARTNERSHIPQ# LLC0# 4350 1 COMPANY NAME [ CoastaI Mechanical I ADDRESS 21 L Fruean Ave 1 CITY South Yarmouth STATE MA I ZIP 02664 TEL 508-737-8747 I FAX r 1 CELL 508-850-6955,J EMAIL Iisa@coastalphc.com