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Home My WebLink AboutBLDP-21-001451 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,E1.5,0=ria CITY YARMOUTH MA DATE 9/22/20 PERMIT# BLDP-21-001451 x 'z JOBSITE ADDRESS 143 ROUTE 6A OWNER'S NAME MCALLISTER JOHN J A7� OWNER ADDRESS MCALLISTER PAMELA 143 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES l 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 1 WATER PIPING 1 OTHER 1 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❑ 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 at 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 at plumbing work and installations performed under the permit issued for this application wit be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Paul Poyant LICENSE#1630 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PAUL R POYANT ADDRESS PO BOX 282 90 TRANQUILITY ROAD CITY REEDVILLE STATE VA ZIP 22539 TEL FAX CELL EMAIL ROUG11 PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES OK /e/z/zee, C Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Vg/ Yq 2 a,,-i-N RT" _ MA DATE PERMIT# 6�I�a I-b D NSA =1�=� CITY Lf 1C� 6 4 OWNER'S NAME (27-Pteo .q JOBSITE ADDRESS f I� - ay.if OWNER ADDRESS / 7 3 fry . TEL b—7 C frY TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT PLANS SUBMITTED: YES ❑ NO CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ FIXTURES -1 FLOOR- I 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN - INTERCEPTOR(INTERIOR)KITCHEN SINK LAVATORY _ I; ROOF DRAIN SHOWER STALL _ SERVICE I MOP SINK _ ' ' - TOILET li I URINAL WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES I WATER PIPING ✓ OTHER ✓ INSURANCE COVERAGE: 1 have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESXf 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 ' p ce with men vision of t e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ---PA U L. -?4`1 A/' LICENSE # )( SIGNATURE MP JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑# COMPANY NAME -J L S uM♦3 till ADDRESS P A O"�j A' 4 \ CITY SA ska V•) t C #4 STATE *14 - ZIP 0? r(, 3 TEL‘O— 72O- a a 30 FAX CELL 50 F.— 7 —g23 0 EMAIL 2 M A ,-- -�0 • (o,