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Home My WebLink AboutBLDP-22-006381 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK q,4r CITY YARMOUTH MA DATE 5/4/22 PERMIT# BLDP-22-006381 t, JOBSITE ADDRESS 17 MOSS RD OWNER'S NAME James Kennedy P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:El RENOVATIONS.El REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK TOILET 2 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 Paul Dacey LICENSE W1740 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME PAUL J DACEY ADDRESS 50 PLATT ST CITY ABINGTON STATE MA ZIP 023511406 TEL FAX CELL EMAIL Ipdaceyphl@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ nrrsaarr FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ._ - CITY ��I�j'1/10 �/ /i 1 MA. DATE PERMIT# 7'1- L 3 S I _li_s JOBSITE ADDRESS /7 ,/2655 RCS' OWNERS NAME MPS /(1 4:/y POWNER ADDRESS 1 7 &O s iRd TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL 0 PRINT NEW:® RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES El NO ❑ CLEARLY FIXTURES 1 FLOOR-. BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS , DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER /" FOOD DISPOSER FLOOR!AREA DRAIN _ - INTERCEPTOR(INTERIOR) KITCHEN SINK / _ rR E a LAVATORY 3 ROOF DRAIN SHOWER STALL o2 • 04 2022 SERVICE/MOP SINK TOILET a L- - BUILD!VG I.J PART v7ENT URINAL fly _ WASHING MACHINE CONNECTION --- WATER HEATER ALL TYPES WATER PIPING / OTHER , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142. Yes 0 No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ❑ BOND 0 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 BOX ONLY: OWNER 0 AGENT 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding •is ap•lication are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the 'rrmi issu-d for, hi . ••lication will be in compliance with 1 Pertinent provision of the Massachusetts State Plumbing Code and Cha r-r oft•- Ge; r. Law . PLUMBER NAME f i U/ 1 .//ge-1`_/C SIGNATURE ./ al'7y ' LIC# � MP❑ JP 0 CORPORATIONj� �1❑# PARTNERSHIP # LLC ❑# COMPANY ME 6)91.I /]/ CL°5 C '9// ADDRESS: 50 /r/4 H . CITY 1/10 I w e STATE��v// ` ZIP(.4 Yc/EMAIL a c 6 yjd A h o LLLF l,('(L TEL CELL FAX -_ CK- (4o6:,.c