HomeMy WebLinkAboutBLDP-21-001818 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 1017/20 PERMIT# BLDP-21-001818
rari 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 El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El
FIXTURES 1 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 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
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 Michael Mcbride LICENSE 18681 SIGNATURE
MP El JP El CORPORATION El# PARTNERSHIP El# r LLC El#
COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive
CITY West Yarmouth STATE MA ZIP 02673 TEL
FAX CELL EMAIL stinger.mcbride@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES r 't
P-1 h C 3 4/ /Zd2f9 Yes No
/ THIS APPLICATION SERVE AS THE PERMIT ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
i/ZAP .' I°19RreC '
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
,, PERMIT# aC. �"21f COI&le
w .E=_ CITY 0MA DATE
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JOBSITE ADDRESS e, OWNER'S NAME a a
p OWNER ADDRESS �j 631 TEL lc-.41..D ( 71 FAX
r
TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL 0 RESIDENTIALXI y r�SL Co � +!'�
PRINT YES, NO®
CLEARLY NEW: C RENOVATION:W REPLACEMENT: PLANS SUBMITTED:
FIXTURES Z FLOOR--► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB l.—_-.1(_-_JE,:_11L1.. +-_.:�.-._..�. E .1 ,..�..�11. 111=3... _ I ..- fi.-�....,..-1
CROSS CONNECTION DEVICE �_.�„�. 1.i____-_ -,_#.� ��..�__-.....lI—. 11 Y 1--it .. ; I.--:�kI __1�i`a i...
DEDICATED SPECIAL WASTE SYSTEM _ .__ , �,.__ 1.- 1 �__I_ _A_____._i El — l - �_ii 1, .._ -1 i
DEDICATED GAS/OIUSAND SYSTEM i --�l�r !—_JL � .•�� 11_, - '- "`.
DEDICATED GREASE SYSTEM �a.- I�.�___,1
DEDICATED GRAY WATER SYSTEM I__. 1 = I.-�.--.1 .� —J __-J-11�-. L---it--. �_ L� 1 ,1_ ` ' _I'
DEDICATED WATER RECYCLE SYSTEM J,__ � �. :IT 1 ___ L�._ ►,L. _ 1L- _ �- r,L _LL 8 1__J --g
1.
DISHWASHER L . _ s=.�.<;� L��� �,� ;�.....- �_ i .9. - r-L.� ._o
DRINKING FOUNTAIN !- �.L iL -r - I = L —IL—It 'L.a�IL.,....�.II ,1.�..�- 1
FOOD DISPOSER I I - Jr—ail—DI 1 r- IL I _ `_`.1 - JJ «
FLOOR /AREA DRAIN �. ,�` I - L,. L.- � .___ I ,.,.. -_'..I
INTERCEPTOR (INTERIOR) ,. 11.----11 .-.- � - :- _L a,E-11
I. ;. _.1=1 J„ _ ' ('--
KITCHEN SINK -1 k_.,___L,.,1I~—''aft _ .1. -.J..F.r i--.._.! .t_.. ; 1.�.. 11- -.�..11[.�.s.�.�T. — ., I - i
LAVATORY �1 _ D I 11 I,- _ .-m 1�—...i i,__ D 1 L____� L._.r_ J L�..�-- $. -�.1
ROOF DRAIN �_� { ..._.1�__._.�:��.. -_ �,..�7 o-.......1771 •� _----�------�. _ .-.���
SHOWER STALLW!),,,,,L_IL.1:::-.11 .a_e i . ,,r_, _ a _�.� [,,.r.Q....�11_....-�, .�.-JL �-,
SERVICE / MOP SINK 1__...= 11L__ _.J i_v ' -�1 .,�i!^ ls..��.�1�_-_�-11.__���t�...,.. =-CD .�..fI_J
1 .r _. ; E��I i IL_IL,„:,..�. t__. ril e.„,_11__..
TOILET � - - r ,--,__ __IL___-- - _ ._ ---�.= �- r
URINAL ! }- --117L7.71...
� �` .�,- , �I � 31 �I_�,.�-.11„_-.. __�I,�.� I11�-�-�1�-_,-�L._�.L-�_
WASHING MACHINE CONNECTION II_ 1!7�,1... L.�..:11�_ . ��-.T. -11_4._..,;„..•-�._--��`-L.�. - �n-� 1,L._ . :°
WATER HEATER ALL TYPES j, 1a 11_ - i a` -�,. = �.�.J ..,.... ---AL....y.....11�;.. _„1 _- I .� J ...�.�1
WATER PIPING �-! �' �1-- �M '_`�� 1 _- -��
�� air
OTHER I .. 5 L.,. _... f. 1,--11_ l 1 L. _..___J L,..i - -- i—_-�...1- �-
(�.� — - .�.-� _�E —.�. ��.� .= e-Q� .ter �4- ..�-a
._�. Div i Ai i
INSURANCE COVERAGE: LULU
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. `YES ( NO Li U .
Yi 1 E._,1i'46 PA i: ' L
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF
COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ��__: �—_„- t
LIABILITY INSURANCE POLICY Yj OTHER TYPE OF INDEMNITY BOND [� Ci
byChapter 142 of the t 4>°
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coveragerequired P
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT LI
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 ssued for this application will be in compliance with all P inent provision of the
State PlumbingCode and Chapter 142 of the.General Laws. !
Massachusetts �PLUMBER'S NAME U ` ` C t` LICENSE # L7L] SIGNATURE
MPLJ JP [_ CORPORATION!#2r'C)f ;PARTNERSHIP®# F LLCM#
�--, ADDRESS7 (i -i---tc-- 0 rive
COMPANY NAME, � � \
CITY W C- >rM a HA tSTATEUM+ZIP _ 7 J TEL Liy d ,'} ! -f z J
FAX _�_I CELL • j EMAIL 7 .te Lr 6 5 „ , - ,i t _ c c;,,,\ i
r
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE:S PERMIT#
PLAN REVIEW NOTES
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