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Home My WebLink AboutBLDP-23-002643 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/14/22 PERMIT# BLDP-23-002643 JOBSITE ADDRESS 124 PLEASANT ST OWNERS NAME CAVANAUGH ROBERT J P OWNER ADDRESS CAVANAUGH NANCY A 124 PLEASANT ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 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/OILJSAND 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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 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❑ 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. PLUMBERS NAME David Townsend LICENSE 18945 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 271 Main St. CITY Plympton STATE MA ZIP 02367 TEL FAX CELL EMAIL D.TOWNSEND89@OUTLOOK.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES ‘4., MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK -"-f CITY off2--j. MA DATE /77 3-`� PERMIT# 'L •--1-4 Li3 .XBSITE ADDRESS Z22 V PJt cf L I- S"f OWNER'S NAME /l/ / C 14N 4 ti( OWNER ADDRESS 5-049 FAX TYPE OR OCCIPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO 0 FIXTURES 1 FLOOR-+ BSt 1 2 3 4 5 s 7 e 9 10 11 12 13 14 BATHTUB , , , , CROSS COWNEC1'ION DEVICE • , DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/0IUS1NC SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ___• 4 DISHWASHER / _ DRINKING FOUNTAIN FOOD DISPOSER - , FLOOR!AREA DRAIN ,..---- ► , INTERCEPTOR f! ORR r - ► KITCHEN SINK i , r LAVATORY ROOF DRAIN 4 l SHOthER STALL SERVICE t MOP SINK • ► / + 9. - TOILET DIAL WASTING M1vMI E CONNECTION 4 i WATER HEATER ALL.TYPES WATER PIPING / OTHER _ - ,- _ . _ , - • _ 5 . + . I INSURANCE COVERAGE: I have a corer*imiguinsurance policy or its substantial equivalent which meets the requirements of MCI. Ch.. 142. YES Fie NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY 0 BOND OWNER'S INSURANCE WANER I am aware that the icensee does not have the insurance coverage required by Chapter 142 tithe Massachusetts General Laws.and that my signature on this permit application Eglim this rrequiren esL CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify Mei all of the details and infammrlon I hove armed er wowed weft this applicabon are aye and scarabs b the beet al my kneetiedge and abet ad pan tlnp wort and it eadallo ne performed under ern pearl lesued for Mk appi anion wii be in cx r snoe%Oh al Parfnerrt maiden Massadaaefls Mae Plumbing Code and Clavier 142 of the Ganoai Lana. stair.. PLUM S NAME Delo') Tb.►Ir J v 4 LICENSES 1 TURE MP Er .IP(V CORPORATION❑• PARTNERSHIP❑# LLC ar9 3{01, COMPANY ME "-SS 0 f L4Cr c9-7/ /17fti ry cr. - — CITY 91-ymp _MA/ STATETM VP OC 3 0 7 Ta '957 a /G'_ FAX GELS. EMEMAIL '� • 46 4 w rt S r vx d e 7 fix. -(0a1C. - Cofe/Y\