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Home My WebLink AboutBLDP-23-002389 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH J MA DATE 11/1/22 PERMIT# BLDP 23 002389 JOBSITE ADDRESS 45 LOWER BROOK RD OWNERS NAME MALONE JAMES J P OWNER ADDRESS MALONE MARY B 45 LOWER BROOK RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL. ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO 0 FIXTURES Z 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 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 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 PLUMBERS NAME Adam Larsen LICENSE 38750 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [TAM LARSEN ADDRESS 8 FARNHAM ST CITY BOSTON STATE MA _ I ZIP 021192908 TEL FAX -I CELL EMAIL monomoypandh@aol.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 __"w. CITY (�g;!�u-C�vt� / MA DATE �C'` ' /l PERMIT# �3 ?L�'fr� •�(, CT 3 1 �2L91TE ADDRESS Lis l�(ij v �C L. co OWNER'S NAME..-7. OWNERS 0 I/�11�,� POWNER ADDRESS TEL ' 7 1ST 3': 14 "� TYPE OR OCCUPANCY TYPE COMME AL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR--+ BSM 1 2 3 4 5 6 7 B 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 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY fl ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET ey- r _ URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _ WATER PIPING OTHER I _ I 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 EY 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. `t CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT !`:-=.1 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 complianc with WI Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. . PLUMBER'S NAME LICENSE#3--5G SIGNATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ��)�lv"� ''1��..�.Al ADDRESS CITY (--�% v1 � TATEM- ZIP 0 L-66) TEL 1' 1O-6- Wb FAX CELL EMAILYk V1�} ?c � LQ1io L . &A... ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT ft PLAN REVIEW NOTES 1 J