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Home My WebLink AboutBLDP-21-001561 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 64: CITY L{ARMOUTH MA DATE 9/25/20 PERMIT# BLDP-21-001561 fLE' JOBSITE ADDRESS 49 MAINE AVE OWNERS NAME ELLSWORTH PHILIP J P OWNER ADDRESS 'ELLSWORTH JOAN A 257 SOUTH SEA AVE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES t 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 1 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 INSLRANCE POLICY El OTHER TYPE OF INDEMNITY❑ 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 s gnature 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 Michael Mcbride LICENSE 118681 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# J COMPANY NAME [AICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX —1 CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBINGINSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES GA. 9/1iavz0 No THIS APPLICATION SERVE AS THE PERMIT S{?O(414 V+LVL- K.r3 C(S4-7 n/G FEES$ PERMIT k C' T PLAN REVIEW NOTES Pine .' Pfigedie • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .•. ,I DATE PERMIT# [JL)Y�� V 1SC0 d -- _ / G 7- 4.!_1L. ____ MA Urn 1--Ili= CITY ; _ L � _, . OWNER'S NAME -._- . � r JOBSITE ADDRESS 9 j ,( ` y � _ p _ OWNER ADDRESS r .�j TEL /SI. -f_aZ7JF V Y TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL U RESIDENTIAL 4. J i I'✓�.'- -rt �.✓'� PRINT (��1 c.l ' CLEARLY NEW: U RENOVATION:Ea REPLACEMENT: U -FLANS SUBMITTED: YES Ki NOD FIXTURES Z FLOOR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB L-- -- CROSS CONNECTION DEVICE - _:' . ; - _II -- _ _ _ _.a DEDICATED SPECIAL WASTE SYSTEM _ IL - _ DEDICATED GAS/OIUSAND SYSTEM .. .~ 1 DEDICATED GREASE SYSTEM E . _a -_�_: , . _ - _ : - - -- DEDICATED GRAY WATER SYSTEM Mr-_:-ff-j,__ _ ' 7., .; „.,—,-11 ... _ ____,_:1L _ _ • _ 1/1! ___ 1 .1.71111 DEDICATED WATER RECYCLE SYSTEM M.,[7....-77. _�a Z.A. .,- EEE1EP ----inui.,_ TOILETINTERCEPTOR (INTERIOR) . 1.,,..._____. 1_1==i="11.111:17:D- M.; ' illEIMMIII LAVATORY 7-11_._ .1_____11,._____.i.„___ _ 11___Ti FLA 1.______IL . _ 11 _ t___IL.---1110_I SHOWER STALL i . .- 11 ..,i___C77,1 . _:,, .., ,.._ !I__ 1' I.--IL IL _1 ._,....._ 1111‘1_1 SERVICE/MOP SINK L____ i__ 1,.. • _ .1,. .. 1=-1_1 :: _._11_ _ 11 . i _ _11.__, 7.7.2--L_.Inta _ RMIN-17---?'MatilanannalirM CONNECTIONWASHING MACHINE it,-__ H _.;H4 -_—HHHHH ♦ ♦ - •� ram ! lH.m- ' lww - - HH-f } WATER PIPING --C---- -----'- ..... 3 OTHER _ _ _ ___ . . , L ;1 _ 1--- if-li ._ 1 _ li 1 ' . _ _a-----zi _..1 . • il - . JUN_ - . 1WirM. WIF.:MM-i_ 11110W1111111_111101111111111 _ ._. 1 - — -- ' E -11M1. LJillik- IL. CJLJL"--=' • . Nam - t CB { - -., - ----- - 4--.., --- .1 -L.- jMWEllitillE. -MM-0.1 •,- - ._ 1 lowituiL _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES , NO U IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY U BOND U • • 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 U AGENT U 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 ibe in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. . n PLUMBER'S NAME )0/ 4 abe-i.4( _.J LICENSE# 1W!4 : - SIUNAT MPU JP CORPORATION(j#n.2 f li PPARTNERSHIPU#L LLC( # NMI COMPANY NAM (A r i (9... i) f- 1i 1ADDRESS / /? --..i -i CITY 4 Jr riV ti STATE NM ' ZIP 7 4 _^s fs TEL FAX CELL `� i u EMAIL ,1 A i ' ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE:$ PERMIT# PLAN REVIEW NOTES msr { '47 f.^a F. • ss d