HomeMy WebLinkAboutBLDP-22-001686 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
ik,., CITY YARMOUTH MA DATE 9/23/21 PERMIT# BLDP-22-001686
v JOBSITE ADDRESS 9 CAPT BEARSE RD OWNER'S NAME KUEHN JOSHUA J
P OWNER ADDRESS 9 CAPT BEARSE RD SOUTH YARMOUTH,MA 02664 _ TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES El NO❑
FIXTURES 1 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 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN _ _
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1 _ _ _
SERVICE/MOP SINK 1
TOILET 1 _
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER 1
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 0 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 Alan Bishop LICENSE 3t1513 SIGNATURE
MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ALAN W BISHOP ADDRESS 23 DANVERS WAY
CITY HYANNIS STATE MA ZIP 026012500 TEL
FAX CELL EMAIL alan@awbishop.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
-- - - - -- THIS APPLICATION SERVE AS THE
FEES$ PERMIT
PLAN REVIEW NOTES
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CI r ...tem. . ,..._
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
k. I K�- MA DATE PERMIT#
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LEI icv, JOBSITE ADDRESS ' J;'. OWNER'S NAME "jam
i P OWNER ADDRESS i TEL 'FAX:
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04, TYPE ORI OCCUPANCY TYPE COMMERCIAL EDUCATIONAL E RESIDENTIAL.__
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RL NEW: _-__, RENOVATION: _ REPLACEMENT: PLANS SUBMITTED: YES __' NO,
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FIXTURES-1 FLOOR-' BSM f 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _ i A N
CROSS CONNECTION DEVICE - i ' -I ' i
DEDICATED SPECIAL WASTE SYSTEM
9
DEDICATED GAS/OIUSAND SYSTEM - _ _ ._-
DEDICATED GREASE SYSTEM I __._. 1.. -
DEDICATED GRAY WATER SYSTEM 1 i j ' ' ; — ''I -
DEDICATED WATER RECYCLE SYSTEM k v I -�
,
DISHWASHER d _ _ �r _1 r
i ; __
DRINKING FOUNTAIN F �
FOOD DISPOSER `r -r— —''—
FLOOR/AREA DRAIN �__-- r-- --..__.._...
INTERCEPTOR(INTERIOR) r
KITCHEN SINK - j- -—-__ f ___ n r I
_._
LAVATORY _ ,,- t7ii _ __1
ROOF DRAIN .I
SHOWER STALL 4r._._
fir...___
SERVICE 1 MOP SINK ) iI i
I TOILET ' ..t ._ r I---,IF I -1. 1 ii
URINAL -- —,— - - - - - T
_
WASHING MACHINE CONNECTION y
r
WATER HEATER ALL TYPES _i_____ " J ' ; —___ 4_ ____
WATER PIPING -- ' - - L_.- — ;
OTHER — - -_-I- _— __
1 .; )_
•
i
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESZ1 NO jJ
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BONG
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 all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME _ LICENSE# _ SIGNATURE
MP;—; JP , CORPORATION'#I 1PARTNERSHIP! i#' I LLC�` ____'
. COMPANY NAME!__ ADDRESS r '
CITY !STATE I ` ZIP — --- , r------- -
TEL
FAX -- CELL . 1 EMAIL P