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Home My WebLink AboutBLDP&G-22-004486 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u� -r CITY YARMOUTH MA DATE 2/14/22 PERMIT# BLDP-22-004486 f ?: JOBSITE ADDRESS 20 QUARTERMASTER ROW OWNER'S NAME Saraswati Khanal P OWNER ADDRESS 20 QUARTERMASTER ROW SOUTH YARMOUTH,MA 02664-1649 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES • FLOORS-4 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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 hereby certify that all of the details and information I have submitted or entered regarding this application are tree 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*B681 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.corn ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES R JE E I V S CHUSETTS UNIFORM AP,PLICATION FOR A PE IT TO PERFORM PLUMBING WORK _` MA DATE iI �v 2Z PERMIT# Z-�'— LIh b �. [ "1 JOBSITE DRESS � 0�ct�� t-cr-fG� OWNER'S NAME ��r`'(� � ?A p C BuntBy _OWNEvG DE R RESS 1 TEI ,, --- — � 7� �,?_-2��' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 1,83 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES El NO FIXTURES 1 FLOOR—+ 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/OIUSAND 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 ` ROOF DRAIN SHOWER STALL SERVICE!MOP SINK I TOILET t 1 URINAL . j WASHING MACHINE CONNECTION i 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 RI NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY ® OTHER TYPE OF INDEMNITY 0 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. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L`-I I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accui-ate 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 otthe Massachusetts State Plumbing Code and Chapter 142 of th General Laws. �//,, \ ` PLUMBER'S NAME "1 Gina e(� I\ r f«4 LICENSE# ' I `�� ! \ SIGNATURE n MP❑ JP( . CORPORATION❑# PARTNERSHIP❑.# LLC❑# Pro r ' COMPANY NAME v 'Iy G r I O�� f I �`� ADDRESS �� G n t.�1 l ✓1 �'G��(/� CITY G r1 n� ) STATE h. Af,l V r7 ZIP a 2.66 ( TEL 77y c(r) i/ Z-a FAX CELL EMAIL , l D /B G1l/�A/t. /er ,. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES k , GAS r S i'ACHUSETTS UNIFORM APPLICATION FOR A I,ER IT TO PERFORM FITTING WORK RFC n:s- ,- CITY ' ;•�-:: r� MA DATE 0-2— PERMIT �; 2-1 k 6 FEB 1. 1 2 IT AD DRESS 2_0 0 51-P�� rO � r - ,OWNER'S S NAME aui�. "`� . DEL 1,ADERESS (77V)TEL ?48 - Z/ 2_ FAX________________ PRINT OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 101J,4L ❑ RESIDENTIAL CLEARLY NEW: ❑ RENQVATION: ❑ REPLACEMENT: 74, PLANS SUBMITTED: YES ❑ NO APPLIANCES 1 FLOORS-* BSM 1 2 3 4 5 6 o BOILER 9 10 11 12 13 14 BOOSTER CONVERSION BURNER COOK STOVE i DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR + FURNACE GENERATOR GRILLE `J INFRARED HEATER — LABORATORY COCKS ---- MAKEUP AIR UNIT • ; ___.______L______n OVEN I POOL HEATER ______#__: ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER �- WATER HEATER / OTHER --I INSURANCE COVERAGE I have a current liabrfi insurance policy or its substantial equivalent which meets the requirements of IVIGL. Ch . 142 YES [ NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY 56 OTHER TYPE INDEMNITY ❑ BOND • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurancei Massachusetts General Laws, and that mysignature on this permit application waives this requirement.vrequired by Chapter 142of the + SIGNATURE OF OWNER OR, AGENT CHECK ONE ONLY: OWNER ❑ AGENT El ,1_ I hereby certify that all of the details and information I have submitted or entered regarding this `� and that all plumbing work and installations performed under the permit issued for this g application will b application are true and withal accurate to the best knowledgef pi �• Massachusetts State Plumbing Code and Chapter 142 of the General e in compliance with all Pertinent provision of pie Law PLUMBER-GASFIT ("ER NAMEMIC.J\CeeC.-_ tJ� r/Li 1 SL R LICENSEt 17b� SIGNATURE MP ❑ MGF ❑ JP 15g JGF ❑ LPG' ❑ CORPORATION ❑ iF r_ 1 (Thc P • PARTNERSHIP ❑ �r ALl (' 7 COMPANY 'LAME I ADDRESS �'GI.1) I CITY A 4 L STATE 04,54 . ZIP 1 W O TEL O.- FAX CELL EMAIL • ..., 1111 -' A 14 2 I A ,� u _//L. ° C ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY • FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT It PLAN REVIEW NOTES