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Home My WebLink AboutBLDP-21-007515 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/25/21 PERMIT# BLDP-21-007515 JOBSITE ADDRESS 62 LILY POND DR OWNER'S NAME CARBONNEAU FRANCIS J P OWNER ADDRESS CARBONNEAU DONNA J 62 LILY POND DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT El 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 at 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 wit be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Glenn Raymond LICENSE 1A819 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME GLENN R RAYMOND ADDRESS 2 JIBSTAY RD CITY YARMOUTH PORT STATE MA ZIP 026752034 TEL FAX CELL 5083676403 EMAIL glennraymond@efwinslow.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 _ � . " CTY 4144roldd it MA DATE 6 — 5 — 1 z ' PERMIT# tl-l)1'- 1 I -oe,1 S c i_ . _l`I=a JOBSITE ADDRESS 6 a. ;I y P.,,,,,,...) 1.)r, e OWNER'S NAME F,Awl( CAr r3c,va.eL, >a� POWNER ADDRESS ccz v TEL c't 78 30 ->»°/ FAX i e!.: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT T PLANS SUBMITTED: YES❑ NO Er" CLEARLY NEW: RENOVATION:❑ REPLACEMEN ❑ LrJ FIXTURES-I FLOOR—. 8SM 1 2 3 4 5 6 7 T 8 9 10 11 12 13 14 BATHTUB • i CROSS CONNECTION DEVICE ! DEDICATED SPECIAL WASTE SYSTEM ! 1 DEDICATED GAS/OIL/SAND SYSTEM , DEDICATED GREASE SYSTEM i I T DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM - DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN I I INTERCEPTOR(INTERIOR) KITCHEN SINK I - LAVATORY ROOF DRAIN SHOWER STALL / SERVICE/MOP SINK TOILET / URINAL WASHING MACHINE CONNECTION ' WATER HEATER ALL TYPES WATER PIPING ; / OTHER L INSURANCE COVERAGE: —/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO l 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. ' CHECK ONE ONLY: OWNER GENT ❑ 1 SIGNATURt OWNER OR AGENT I hereby cert'tfy 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;all P nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Genera.Laws. ' __ PLUMBER'S NAME GkL'v',/ �� ray Y71'8 1' LICENSE# 19 S 19 SIGNATURE MP[-''' JP[ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME. ADDRESS .2.' - ?) ii4y _l7 CITY (---crkf wkc�ic PoiT STATE )4//64 • ZIP O2Co75' TEL Sr'? - ?G ]— 6Y03 FAX CELL .c a_444..ig EMAIL 6-le u rt,/?,.4y07 ca.C.) L F(c-):,,.. Colow , :K ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES