The URL can be used to link to this page

Home My WebLink AboutBLDP-21-005196 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ria, CITY YARMOUTH ] MA DATE 3/12/21 PERMIT# BLDP-21-005196 tiro JOBSITE ADDRESS 51 LONGFELLOW DR OWNER'S NAME MEAD MARY L p • OWNER ADDRESS 17 STONE RIDGE RD BREWS--ER,NY 10509 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 1 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 4 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK _ _ TOILET 3 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❑ NO ❑ IF YOU CHECKED YES,PEASE 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'or 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 Stephen Ewing LICENSE 15281 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEPHEN D EWING ADDRESS 140 WHITE MOSS DR CITY MARSTONS MLS STATE MA ZIP 026481080 TEL FAX CELL EMAIL steve@edgewaterplumbing.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yea No THIS APPLICATION SERVE AS THE PERMIT 0 ❑ FEES S PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK —4 7, CITY(Yarmouth �� _ MA DATE 3/12/21 PERMIT# -L-O? 24- "4' S I(j JOBSITE ADDRESS 151 Longfellow Drive OWNER'S NAME. A�-wyer POWNER ADDRESS TEL 508-294-6287 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL CI EDUCATIONAL ❑ RESIDENTIAL E PRINT CLEARLY NEW: RENOVATION: i REPLACEMENT: ' PLANS SUBMITTED: YES % NO❑ FIXTURES-1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 BATHTUB Ismil .M111101 I IIMMIIIMMIIIIIIII i -CROSS CONNECTION DEVICE j �^DEDICATED SPECIAL WASTE SYSTEM LI_ I_ � mmom mum DEDICATED GAS/OIL/SAND SYSTEM _ug DEDICATED GREASE SYSTEM milimmig. �Li MM. �� m DEDICATED GRAY WATER SYSTEM Mir mom -EN ININFMMIIRM® DEDICATED WATER RECYCLE SYSTEM m umin 11111-71.11111111 DISHWASHER SRI 1 MINI ' El 101111111.1111 DRINKING FOUNTAIN r�� ME r- 1 ~ -El Nil FOOD DISPOSER FIM_MI MEI®WNW 11111 N® FLOOR/AREA DRAIN MII; I�� M INTERCEPTOR(INTERIOR011111.11111111111..— IlL r KITCHEN SINK it'd � mi I11.1111111 LAVATORY anI 4 r NM. MOM ROOF DRAIN 7 IMI EMI= MINIIIII SHOWER STALL 11111111111nm MR 1111.1.111111111111 SERVICE/MOP SINK MIMI MIK VINE IMAIIRMIR'_ _ TOILET 11111111111111111111111111111EN®i � URINAL �� I T i 1 MINI WASHING MACHINE CONNECTION 01111111117111111•111+,' _ r---!MIMIME WATER - _ � ;I WATER PIPINGR ALL TYPES M�= =� a =I—I MTMI OTHERMISIMIIITISIONIMINMrounim INEdial 1 MMEIMMME won r I -__ MIS: own mom _-- INSURANCE COVERAGE: _ I have a current Iiability_insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ; NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 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. `� PLUMBER'S NAME Stephen D.Ewing LICENSE# 15281 SIGNATURE MP _d JP CORPORATION d#L3672 PARTNERSHIP #L.__ LLC❑#I COMPANY NAME' Edgewater Plumbing&Heating ADDRESS P.O.Box 656 _- I CITY'Sagamore STATE MA—I ZIP 02561I —I TEL L08 317 9680 FAX CELL I 508-737-0077 EMAIL rsteve@edgewaterplumbinginc.com ____ ill(0