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Home My WebLink AboutBLDP-22-000852 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t r CITY YARMOUTH MA DATE 8/16/21 PERMIT# BLDP-22-000852 � s 11 ,` JOBSITE ADDRESS 6 5 t-,,i,A)-7c .___371. OWNER'S NAME PAUL MCCARTY P OWNER ADDRESS 33 PHEASANT LANE EAST FALMOUTH,MA 02536 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURFS • FLOORS BSM 1 2 3 4 5 6 7 8 , 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 4 ROOF DRAIN SHOWER STALL 1 2 SERVICE/MOP SINK TOILET 2 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 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❑ 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 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 Ronald Nurse LICENSE 143397 SIGNATURE MP ❑ JP D CORPORATION D# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD W NURSE ADDRESS 221 COTUIT RD CITY SANDWICH STATE MA ZIP 025632655 TEL FAX CELL EMAIL ptech88@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMIT H PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _:.,_ __J;_ CITY J(AI 14..rit� '� MA DATE PERMIT# • ZZ - JOBSITE ADDRESS 6.•i Ct; osA'E'v S A. OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Et PRINT ' CLEARLY I NEW:[ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I, 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 I AREA DRAIN _ , INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY a y ROOF DRAIN _ a SHOWER STALL ( ..Z j i F 0 SERVICE!MOP SINK I - -- TOILET a 1 1 Y URINAL - 4 2021 WASHING MACHINE CONNECTION l I WATER HEATER ALL TYPES (WATER PIPING UI- LL.A UL PAR 1 ME T OTHER - - _ INSURANCE COVERAGE: {have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ca 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 in compliance with lL2euirient provieiow. e Massachusetts State Plumbina Code and Chapter 142 of the General Laws. PLUMBER'S NAME e-cov.,o.\ok (�IJ ice' LICENSE# 1339 7 t SIGNATUR MP JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# I COMPANY NAME -' \0‘..- 'v33 Pc krAYeN.0\c3B-1 ADDRESS 9 CITY 5 cx-c-\.r I STATE ^' ZIP (:4 5 d 3 TEL _ 2130 "4/c'6 y 1 ! FAX CELL EMAIL '{f' (1, f' I �3v 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 ___