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HomeMy WebLinkAboutBLDP-23-002868 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITY YARMOUTH MA DATE 11/23/22 PERMIT# BLDP-23-002868 tf- JOBSITE ADDRESS 37 PINEWOOD RD OWNER'S NAME OBRIEN DIANE G P OWNER ADDRESS CHASE E W&OBRIEN S M 37 PINEWOOD RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL CI PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YESD NO❑ FIXTURES 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 ROOF DRAIN SHOWER STALL 1 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❑ 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 Joseph Rausa LICENSE 113445 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSEPH A RAUSA ADDRESS 10 SANTO ST CITY PLYMOUTH STATE MA ZIP 023605250 TEL FAX CELL EMAIL nebathspermits@longhp.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES: PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -7-110 . CITY Yarmouth 1 MA DATE 11/16/22 PERMIT # JOBSITE ADDRESS 37 Pinewood Rd West Yarmouth MA 02673 j OWNER'S NAME Diane OBrien POWNER ADDRESS 37 Pinewood Rd West Yarmouth MA 02673 TEL 774-470-2968 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL RESIDENTIAL Li PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES NO ID FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I � ...- CROSS CONNECTION DEVICE - I -iiiii ir - DEDICATED SPECIAL WASTE SYSTEM _j _ - 1 t� — - j DEDICATED GAS/OIL/SAND SYSTEM �^ ( , DEDICATED GREASE SYSTEM I--- ��'' NM DEDICATED GRAY WATER SYSTEM I U U DEDICATED WATER RECYCLE SYSTEM l: 10111111L l DISHWASHER C _ l I ... DRINKING FOUNTAIN 1{ M FOOD DISPOSER FLOOR / AREA DRAINr ii; ice„ INTERCEPTOR (INTERIOR) "-- I fr- -KITCHEN SINK LAVATORY �' ROOF DRAIN l' ,._. . .___ 0. 7 .:. F 1 SHOWER STALL � . , _ SERVICE / MOP SINK lr-- IIIIIII TOILET IIIMI IIIMII URINAL -- - MO WASHING MACHINE CONNECTION r _ _. __MO - WATER HEATER ALL TYPES *ggli"+""8" IIIIIII ' WATER PIPING OTHER I .__.._.-] Mlii 1-- d ___ILL--. L L____ INSURANCE COVER I have a current liability insurance policy or its substantial equivalent which meets the requirementsh. 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 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 ,I 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 accur to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b in mpliance wit ,6ll ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - 1—N.._ PLUMBER'S NAME Joseph Rausa I LICENSE # 13445 j ' SIGNATURE MP i JP Li CORPORATION _14 ' PARTNERSHIP©# . LLCI v j#14583 COMPANY NAME'_Long Baths, LLC 1 ADDRESS[300 Myles Standish Blvd CITY Taunton STATE MA ZIP 02780 1 TEL [774-244-0576 FAX L CELL L i EMAIL nebathspermits@longhp.com 41'"- '