HomeMy WebLinkAboutBLDP-23-003666 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 115123 PERMIT# BLDP-23-003666
JOBSITE ADDRESS 183 ROUTE 28 OWNER'S NAME THE COVE AT YM ASSOC LTD
OWNER ADDRESS %VACATION RESORT INTERNATIONAL PO BOX 399 HYANNIS,MA 02601 PTNRS TEL
P
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
FIXTURES FLOORS—, RSM 1 7 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
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 3
WATER PIPING 3
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.
PLUMBER'S NAME William Heath LICENSE 1L021 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME WILLIAM 0 HEATH ADDRESS 265 GREAT WESTERN RD 45 Main Street
CITY Sandwich STATE MA ZIP 026452428 TEL
FAX CELL EMAIL billsboat330@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE
FEES$ PERMIT#
PLAN REVIEW NOTES
(L I 1 )-. )
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM
, mo rmi PLUMBING WORK
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TYPE OR OCCUPANCY TYPE COMMERCIAL ! '' EDUCATIONAL Li RESIDENTIAL Q
PRINT
CLEARLY NEW: f RENOVATION:I _ I REPLACEMENT: ft-21.- PLANS SUBMITTED: YES ri NO
P.
FIXTURES 7 FLOOR-► BSM 1 2 [ 3 4 5 6 7 1 8 9 10 11 12 13 14
BATHTUB = 11____-} ,r---- l :1 --�.
CROSS CONNECTION DEVICE ��_ _ i �. � � ,w°' _ __ -- - .�. - -�J. _ ;��i . �
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DEDICATED SPECIAL WASTE SYSTEM � 1 � •' �j - - � ��'
DEDICATED GAS/OIUSAND SYSTEM ' r I :4 t ; • ,f nt
DEDICATED GREASE SYSTEM ' _ 1
DEDICATED GRAY WATER SYSTEM ! '.-.1 1 : .` `- �
DEDICATED WATER RECYCLE SYSTEM .J !1��: -j _ J I t l -�--
DISHWASHER 7---., 1------,. ..
DRINKING FOUNTAIN ' '11 r - -- - ._ ; ; ,
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FOOD DISPOSER - ` ;�
FLOOR I AREA DRAIN � � - '�-- 1 �_ 11 'i, f
INTERCEPTOR(INTERIOR) ��'; '
KITCHEN SINK ,
LAVATORY --i • 1.- ---- - _ Hi
~~'1 IM
INK t;
ROOF DRAIN a -{ -' I
SHOWER STALL - --= i - :•-._ .. _--__ _
SERVICE/ MOP SINK I _ - _ , _ t,
TOILET ;- -- - � • - - - : . .. . . _ _ ;
1 t _ -,� _ y __,-
URINAL r . li _ , ` !4-- - — it -� - —I
-.,
WASHING MACHINE CONNECTION l '( - . =i
WATER HEATER ALL TYPES :``- I ° 1 l i``T"
1 3 ,: .MOW=
WATER PIPING T---fF - -=-1 - j 1- I H1 I� !i
OTHER '
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' '. IIVSURANGE CQVERAGE: •17 _ ' ` �. _ :,
I have a current liability 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 rly 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. p
CHECK ONE ONLY: OWNER ( I AGENT 1_ -(
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 �•�:�i4q-�► �,-� �� (�_ � _.�---_,-.-�'
- / __ _ _____=LICENSE # I 1 2-02- i
SIGNATURE
MP 3/ JP n CORPORATION~Lj#' PARTNERSHIPL Jtt1 JLLCfl#j
COMPANY NAME( 6 + tk- .1.c.A 4 , Gt. lp -, ,,,.,, I ADDRESS te f ✓r74- ,,-- _,,-L.,,Z
CITY' S /- �... tr.., i�
, � .L. __ ;STATE FS:'b
Z!P a2 3� , TEL 77 ,� toy ,�
-FAX
FAX ; CELL 77 L EMAIL 1 3, I/s �C r 3 . . . .