HomeMy WebLinkAboutBLDP-23-005072 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 3/15/23 PERMIT# BLDP-23-005072
JOBSITE ADDRESS 134 PLEASANT ST OWNER'S NAME SHEEHAN KEVIN
P OWNER ADDRESS 24 DOCKSIDE LN PMB 112 KEY LARGO 33037-0000 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTIIRFS l 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 _
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 2
ROOF DRAIN •
SHOWER STALL 1
•
SERVICE/MOP SINK
TOILET 1
•
URINAL _
WASHING MACHINE CONNECTION
WATER HEATER
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 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❑
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 Scott Hohmann LICENSE 12430 SIGNATURE
MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME SCOTT C HOHMANN ADDRESS 1146 Dorchester Ave
CITY Dorchester STATE MA ZIP 02125-0000 TEL
FAX CELL EMAIL
.r )I
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ 0
FEES$ PERMIT#
PLAN REVIEW NOTES
`, CMASSAA�CHUSETTS�U{NIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
l\� Y 040.."tiv‘, MA DATE PERM IT# Z3_G��D�"�
MAR 10 �Q� IT AD)RESS S L( C-1C kWJ r 2 - OWNER'S NAME F�C U i A- Tli�Ci'L�yVI
_ OWNER C RESS 'L( �`eQ � S X -T TEL FAX
BUIL�tNG LitfAR1 MENT
6YTYP-F-nR--c)c &C"TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:2" PLANS SUBMITTED: YES❑ NO[j
FIXTURES 1 FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB l
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
ROOF DRAIN
SHOWER STALL I '
SERVICE/MOP SINK 1
TOILET
i URINAL
j WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING j
OTHER
yes
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 I OTHER TYPE OF INDEMNITY ❑ BOND 0
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
1 Massachusetts General Laws,and that my signature on this permit application waives this requirement.
r
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
1`-',I 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 mpliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
6.4G Nl/,��.44c,fr----
PLUMBER'S NAME LICENSE#/ /)4' ' SIGNATURE
MP Er- JP❑ )) JJ CORPORATION[ # PARTNERSHIP D# LLC❑#
/COMPANY NAME 4 �I 7.9n.-,-- a. C_ ADDRESS 1/ � Jr/ e'
CITY . /('`1QJ)-(C/ / STATE A+ ZIP 0� Z �� TEL
U FAX CELL / 7.- Q 2.74 EMAIL C///"7�E/!/yl/Kr'l/ y illOhlYI,h✓I.VIJ�r / 6)43
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
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