HomeMy WebLinkAboutBLDP-22-000240 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
,sr.,. CITY YARMOUTH 7 MA DATE 7/14/21 PERMIT# BLDP-22-000240
t--14 JOBSITE ADDRESS 1 LEEWARD RUN OWNER'S NAME susan watson
P OWNER ADDRESS MA 02148-6203 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURF FL(r)R —0 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
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1
LAVATORY 2 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2 1
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER
WATER PIPING
OTHER 1
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current Iiabilityjnsurance 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 Dennis Gagne LICENSE 91804 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME DENNIS M GAGNE ADDRESS 31 Cherrywood Ln
CITY Marstons Mills STATE MA 7 ZIP 026481761 TEL
FAX CELL I EMAIL gagneamg51@aol.com
RECEIVED
MAP: JUL 14 2021 PARC6e •
EgriMAPiIORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
+'=t� o, • k MA DATE /5? ' - 22-ooi� 40
`' _;•._ CITY �/!?�' e PERMIT2
LEI ,.� n g.,r.r—`— _
JOBSITEADDRESS 04-e kaof-ii ,'nel I OWNER'S NAME ,s p /'t,,----r'xqr 1
P OWNER ADDRESS 1 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL D RESIDENTIAL[2---'
PRINT PLANS SUBMI I I ED: YES® NO❑
CLEARLY NEW:D RENOVATION:[a- REPLACEMENT:El
FIXTURES 7. FLOOR-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB =I I L<_. L_i.: . 11 I L._____ — f_._._
CROSS CONNECTION DEVICE I c i=l 1, T. I_ `l ' (i I
DEDICATED SPECIAL WASTE SYSTEM Im._-Il .=I__J_-- t----.i I - 1—_1=
DEDICATED GAS/OIUSAND SYSTEM I_. ll _ i INL,7, L-_.iLT JI. - L__�___I7 L___11 i[ 1______I
DEDICATED GREASE SYSTEM =L__ L _ IE=_fi_1__ }�3.L I___�� -� - _li J1 1L
DEDICATED GRAY WATER SYSTEM L___ I T__ l,�D, .+= _AL_____I ____L _ _ __,�L,..`-�J- I
• DEDICATED WATER RECYCLE SYSTEM I[- I. i _._- �I •_`/1,_ _ p (J
DISHWASHER • L__--- - L._ _(I..,_11_ I 1 i�o.I - I . - ,. ._.. .(L_.. .1__ ____
DRINKING FOUNTAIN IQ, I L�.. ,�1 I -- k I t L r ,.����` L-='h.� it„,= �I ___1
FOOD DISPOSER I L£1I1 -- $ _.�,�.. Y3..,.. I �� �I=1 1
FLOOR/AREA DRAIN L_ - _ ._ I,,.�-JL._. _.__ _ I I L� I _ ll _ ..L�"
INTERCEPTOR(INTERIOR) .�., I - I J L�L J I I�II.`-"IL J__-___ L J
_KITCHEN SINK a .___II -. (I_---- L- I i= ,_ + ___I L 1111111111.. 111 (
LAVATORY =I;. i�I-.121 ` ( 1I—.I__ 1==*_____J=L I.
ROOF DRAIN =I L-F-I
SHOWER STALL i i - __ i____I i 1 r i.-_._J L.E I ( -l .,_ t _ L- h_1
SERVICE/MOP SINK _ _�.. `I ---1 L-� I L �I ___i L-_--��a I..,... L... L..
TOILET )I ___._.(L_ ... _ -L. _31 77L. - -
_URINAL L_ -L_,._ 1L�1I_�_ __._,L_..-.�.31...�..,_._L.�. _(=L._,�....�I L ___ I L.,..___J
WASHING MACHINE CONNECTION I ? .�.._11__I _ 1 i,____ _•-_)I_..� 9 I I•- _1I__ �it _I___J(I 1I_o .1
WATER HEATER ALL TYPES I (':-JL ai�.`----ry , _ () i1...__I'.. 1 1 __ �I . =1
WATER PIPING L L_ JL 1 _ aL_tL___.JL ;L...,.-JI__�--(I _ I II L�L.. J
iL 11. I— u_.-I�..�Lr. 11 sL. l z _ la.__
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES - NO [j
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ® BOND Q
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 L I AGENT IA
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 of the
w
Massachusetts State Plumbing Code and Chapter 142 of the General Las.
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-PLUMBER'S NAME ,r':-2�/�i I- t L/!�-� J LICENSE# PM1A'G' I SIGNATU�J7i�
MP®' JP CORPORATION( ##3 .3' PARTNERSHIP®# LLCLI# I
COMPANY NAME //J j� / '//d -e I ADDRESS iia,,p
CITY L/71eleh7On.7-j !STATE 19M I ZIP ,,e,V 73 I TEL 79 - ,. 36"c7gY
FAX CELL I, I EMAIL heint®/1A�'/47�liL•Ce/I/ _