The URL can be used to link to this page

Home My WebLink AboutBLDP-23-001058 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/29/22 PERMIT# BLDP-23-001058 f � JOBSITE ADDRESS 101 POND ST OWNER'S NAME FITZPATRICK DANIEL B P OWNER ADDRESS FITZPATRICK MAUREEN A 68 MAYER DRIVE HOLYOKE,MA 01040-1411 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO El 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 1 LAVATORY _ ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 _ WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:ejector pump 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,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 Matthew Mazzone LICENSE 16679 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME ADDRESS 22 old farm rd CITY Spencer STATE MA ZIP 01562 TEL FAX CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITH PLAN REVIEW NOTES :•\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK E_ f. -t CITY \C.1 001./4-i MA DATE r 2.3 -Z Z.1 PERMIT# 2 3 - i o S g JOBSITE ADDRESS l 0 ( Pp y\a - - J OWNER'S NAME r 0l&.r Jacjickeidig POWNER ADDRESS j TEL i FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL V/ PRINT CLEARLY NEW: RENOVATION:. REPLACEMENT: PLANS SUBMITTED: YES NO[( FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1--- � rT U �[ I - CROSS CONNECTION DEVICE [ F� —��- -�—�� DEDICATED SPECIAL WASTE SYSTEM ( J j J J (( i U 1, J 1 1 11U I DEDICATED GAS/OIUSAND SYSTEM ( J J U '' I �J ( DEDICATED GREASE SYSTEM J[ J y ( fl I 1 ,i_____Ft_l DEDICATED GRAY WATER SYSTEM 1_ J I f T i DEDICATED WATER RECYCLE SYSTEM j i. J., J __ ) d LI DISHWASHER JE Jr_____J ) I DRINKING FOUNTAIN �E .J..- [ FOOD DISPOSER -� '7 � FLOOR/AREA DRAIN Fj - ,- i1 INTERCEPTOR(INTERIOR) I � � { i -.. KITCHEN SINK J i _ LAVATORY �� r- I ROOF DRAIN S . ��' SHOWER STALL I 1 • SERVICE!MOP SINK E— ,j r l 11 TOILET ._ 1 URINAL WASHING MACHINE CONNECTION 1r_ [ - - WATER HEATER ALL TYPES 1 J �> M: WATER PIPING OTHER T Q.r k v h. J !_�'. I 1 _ il A 1 I; �. I �- r 1 r 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,PLEASE INDICATE TJ:iE 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. CHECK ONE ONLY: OWNER _ _ AGENT i., ; 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 }sNGk.)t- -Z104\t 'LICENSE# ((Ol,77q SIG A URE MP 7 JP❑ CORPORATION(]# PARTNERSHIPD#E LLC # COMPANY NAME ANC/,.147ne P ! t ADDRESS 'a..)._ 0 ( C( 1 CITY s u, STATE lAkil I ZIP r 0 )S-(p 1 ' TEL S 0 A _ Ll 10 - 3 LE FAX CEI..L L !EMAIL -