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HomeMy WebLinkAboutBLDP-20-005245 .1 '1Y i3z nO/- .AD MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _—, CITY YARMOUTH MA DATE 3/30/20 PERMIT# BLDP-20-005245 JOBSITE ADDRESS 507 BUCK ISLAND RD OWNERS NAME TOWN OF YARMOUTH P OWNER ADDRESS 1146 ROUTE 28 SOUTH YARMOUTH,MA 02664-4463 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:© RENOVATION:0 REPLACEMENT❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 6 DEDICATED SPECIAL WASTE SYSTEM • DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN 1 FOOD DISPOSER FLOOR/AREA DRAIN 35 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 12 ROOF DRAIN SHOWER STALL 6 SERVICE/MOP SINK 2 TOILET 7 URINAL 2 WASHING MACHINE CONNECTION WATER HEATER 2 WATER PIPING 1 OTHER 6 OTHER DESCRIPTION:Misc INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND 0 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 Patrick Harold LICENSE 12459 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Harold Brothers Mechancial ADDRESS 44 Woodrock Rd#2336 CITY Weymouth STATE MA ZIP 02189 TEL 7818712111 FAX CELL 6034015779 EMAIL / ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES n /Tk�..(/- Ycs No7el"" lJ THIS APPLICATION SERVE AS THE PERMIT El 0 6/4 VZ f s) 5 c t//() oFr /7 FEES S PERMIT# /?/ PLAN REVIEW NOTES II) / 4g O 1/ ie) 05-7,te 5� C Lt/� oft e-e 7/1/go 51 s £C C U!6 colt- C1 7hizozo f i L F Y)fl'A IA, ~ Jr"2 1 /y/.2 o •� .d'-A ® I_"i✓r JI x U' O`TJ`C/7/`l(�/Y�Gy 8/7//a J 1 ) rJ II)) WAs164y 146 &6 /%/2 0 4e, 1/ '- /Ol I4/zoto c(CS LViq��t/I P°p2 ac4p1 .- 71-.ci ADM"' 12.1102 Girt��-P. vz t J -Gk-///`-i/2/