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Home My WebLink AboutBLDP-22-000750 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/9/21 PERMIT# BLDP-22-000750 ,,r JOBSITE ADDRESS 8 PIERCE ST OWNER'S NAME Elizabeth Ciampa P OWNER ADDRESS 8 PIERCE ST WEST YARMOUTH,MA 02673 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 1 CROSS CONNECTION DEVICE 1 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 1 INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 OTHER 1 OTHER DESCRIPTION:outdoor shower 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❑ 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 Jeremy Gates LICENSE 26002 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#f COMPANY NAME Jeremy AGates ADDRESS 3 BRANDT ISLAND RD CITY MATTAPOISETT STATE MA ZIP 027391706 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES E PERMIT# PLAN REVIEW NOTES - M— 1/70. Oa AUG 0 9 2021 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK B 'ILrt2__:°==-_i•R1M NT � Z — 7SU M1^j- y By —' `:r` C --w4-- "-e i W? J 1 MA DATE �j 'q'Z PERMIT# JOBSITE ADDRESS K vt er-ce 5 i OWNERS NAMEaf i7pcbC`?t , (1C''"N1c_ POWNER ADDRESS 5-1-1 3ar!) bc,as-D (> TEL 78..) 665 33 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:. REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-, 13SM 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/OIUSAND SYSTEM _ DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM • DISHWASHER 1 _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN ( _ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _ ROOF DRAIN _ _ SHOWER STALL SERVICE/MOP SINK TOILET Z URINAL _ WASHING MACHINE CONNECTION 4 . WATER HEATER ALL TYPES l WATER PIPING 1 OTHER , CAJ i S1r ' ik\ eiic,L7 b ( INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES gNO ❑ iF YOU CHECKED YES,PLEASE INDICATE TH E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:1 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 ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that ail of the details and information I have submitted or entered regarding this application are true and accura to the best of knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian ertinent p on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER'S NAME ev y ()c j 55 LICENSE# �D C��Z�� MP❑ JP r CORPORATION❑# PARTNER 13fl P L►# LLC❑# ! '(1,elP 5 Fr. C(3r,Q vo ADDRESS rfl D �.�A �F,�e�� c k,mot I� `� COMPANY NAME CITY rN C.- v0M STATE `t ZIP C 2.to 0 1 TEL FAX CELL C4 t1 to( 2 0 'r' EMAIL