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Home My WebLink AboutBLDP-23-004156 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/26/23 PERMIT# BLDP-23-004156 rs - JOBSITE ADDRESS 54 PARKWOOD RD OWNER'S NAME SHEEHAN FREDERICK W TRS P OWNER ADDRESS SHEEHAN RITA M 54 PARKWOOD RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES f 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 1 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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,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 at 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 Richard Olsen LICENSE 1A335 SIGNATURE MP ❑ JP D CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 Hokum Rock Road CITY Dennis STATE MA ZIP 02638 TEL 5083855290 FAX r CELL EMAIL OFFICE@OLSENPLUMBING.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -e eiii L V ` MA DATE I PERMIT # 1 i L 5 - E IZ3 ' ,`�`' ' [ 5L ' OWNER'S NAME J E ADDRESS L , � ,� C> YI Will JAN 2 4 �� __ t. OWNER AQD SS I, _... —....._- TEL! FAX I— BUlrNG DEPARTMENT__BIYPQ --R --OCCUPANCY PE COMMERCIAL EDUCATIONAL RESIDENTIAL,. PRINT CLEARLY NEW: L _; RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES -1 FLOOR--, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB � 11_ -_- --- I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM ; I DEDICATED WATER RECYCLE SYSTEM .. —I I DISHWASHER 1 DRINKING FOUNTAIN — -_ __ . FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) - . , KITCHEN SINK 1 LAVATORY ` tIt ii ROOF DRAIN . � � � . ;-- SHOWER STALL SERVICE I MOP SINK — __..:..:_;,___:. ___ m :..f ....___ _.,_..�.:_. _. __ .__ TOILET 1 1 _ .gy a URINAL __. .� WASHING MACHINE CONNECTION I _ WATER HEATER ALL TYPES WATER PIPING OTHER — - I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i 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 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 i 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 acc terto th , s - f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co c t4Pe rovisio e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .— I 1, PLUMBER'S NAME Richard Olsen , LICENSE # [M10335 ATURE MP i JP CORPORATION EI# 2166 PARTNERSHIPII# LLC #( ____.I COMPANY NAME Olsen Plumbing & Heating ADDRESS I P.O. Box 2026. 357 Hokum Rock Road . CITY Dennis STATE; MA i ZIP 02638 ��- TELljl8 385-5290 FAX 508-385-6963 CELL EMAIL O FIGe K1 PL Vi i i LvC . C01`-\