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Home My WebLink AboutBLDP-21-002911 l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r ',-6 CITY YARMOUTH MA DATE 11/20/20 PERMIT# BLDP-21-002911 =. : JOBSITE ADDRESS 2 PARSONAGE POINT OWNERS NAME EDWARDS PATRICIA OWNER ADDRESS EDWARDS GEORGE 2 PARSONAGE POINT YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑v PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES a FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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❑ 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. PLUMBERS NAME William Woods LICENSE 1/1887 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM T WOODS ADDRESS PO BOX 702 CITY W BARNSTABLE STATE MA ZIP 026680702 TEL FAX CELL EMAIL NOW 4 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NO"l'F5 Yes No THIS APPLICATION SERVE AS THE PERMIT � n FEES$ PERMIT# PLAN REVIEW NOTES -- . (201 am"... MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 'B P ZLJ ! j a=__��— CITY �� MA DATE 7 PERMIT#Voc)147/ JOBSITE ADDRESS X /4--i) 9ii4 6 4 ,1 OWNERS NAME .14v/ �'. POWNER ADDRESS —C/h^-c.-P TEL -- FAX — TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL LIB_ PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:Ei----f PLANS SUBMI I I ED: YES❑ NO re=1/-- FIXTURES 7 FLOOR—f BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE r- rdie. / _ , DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM " ' '!I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM — _ _ DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN a INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN • SHOWER STALL • SERVICE I MOP SINK TOILET URINAL l WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSUB ,�, / { I have a current liability insurance policy or its substantial equivz MGL Ch.142. YES V:4 110 ❑ 1 IF YOU CHECKED YES, PLEASE INDICATE THE PE OF COVERAGE B ..is HrrRUHRIATE 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 l' 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 in compliance with all Pertinent provision of t Massachusetts State Plumbing /Code /and Chapter 142 of the General Laws. �.��, _. PLUMBERS NAME/3(`( `'V Q%S LICENSE#//8'o 2 ✓[� IGNATURRE` MP E JP❑ CORPORATION 1:a# PARTNERSHIP❑.# LLC❑# COMPANY NAME A- - d �5 "47-24-46- ADDRESS 6 '°x 7oZ CITY 4 .4 il-f',J STATE M4 ZIP6-V--66 f ,,TEL9 :?&2 9 ' 3 FAX a !2 3 CELL 7 `73 EMAIL/9,� 4S7.0 C�XVj C 6 iAl ft co ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT I I ❑ FEE: $ PERMIT # PLAN REVIEW NOTES I 1 L