HomeMy WebLinkAboutBLDP-22-001214 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
.,: CITY YARMOUTH MA DATE 9/2/21 PERMIT# BLDP-22-001214
JOBSITE ADDRESS 48 PHYLLIS DR OWNER'S NAME PORTER JAMES M
P OWNER ADDRESS PORTER TOULA P 48 PHYLLIS DR SOUTH YARMOUTH,MA 02664-1680 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 1
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
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 El
OWNERS 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 Robert Lalime LICENSE 143701 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑#
COMPANY NAME ROBERT C LALIME ADDRESS 575 Main St
CITY Mashpee STATE MA ZIP 026492054 TEL
FAX CELL EMAIL none
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ CI
FEES$ PERMITS
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
74 CITY2/ /f.M?6)6*// MA DATE / _/6� % PERMIT# ? Z " t Z 1 t'1
JOBSITE ADDRESS '- /' S
OWNER'S NAME
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW: ❑ RENOVATION:f REPLACEMENT:❑ PLANS SUBMITTED: YES Dv'NO❑
FIXTURES 1 FLOOR--I 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 SYSTEM .
DISHWASHER / • _ _
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN —7
INTERCEPTOR(INTERIOR)
KITCHEN SINK /
LAVATORY /
•
ROOF DRAIN
SHOWER STALL ,
SERVICE/MOP SINK ei E. C E 1 V r-
l. TOILET
URINAL /
. WASHING MACHINE CONNECTION tEla H 1 2ft21 1 .
WATER HEATER ALL TYPES / '
WATER PIPING ~
.BUI _DING Utl'A�I ME VT
OTHER By - _ - _ -
I
INSURANCE COVERAGE: �,�
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L�" NO ❑
IF YOU CHECKED YES, PLEASE INDICATE TH PE 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.
1 CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
L'l I hereby certify that all of the details and information I have submitted or entered regarding this application are true an accu a he best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co anc wi I inent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERS NAME l/L/7 /,o/n7-' LICENSE# SIGNATURE
MP[V JP❑ COR RATION❑# PARTNERSHIP❑.# LLC❑
COMPANY NAME ( G /7/�/Yl....-61 ADDRESS c.r7J r (/✓/44r (f�
CITY 1/1P"e'/-' STATE 4i7 ZIP (. W 77 TEL
) /
FAX CELL EMAIL / 'rt- / 4�/ df C¢/ C14'f?7l/1S /.. /- /
ROUGH PLUMBING INSPECTION NOTES
BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES