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HomeMy WebLinkAboutBLDP-23-005611 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/10/23 PERMIT# BLDP-23-005611 ��� JOBSITE ADDRESS 97 CAPT BACON RD OWNER'S NAME OROURKE PATRICK J P OWNER ADDRESS OROURKE JOELLE E 97 CAPT BACON RD SOUTH YARMOUTH 02664-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO FIXTURES 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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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 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 Ronald Hague LICENSE 7;636 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD J HAGUE ADDRESS 62 NEW BOSTON RD CITY DENNIS STATE MA ZIP 026381901 TEL FAX CELL EMAIL ronhague©comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES __ CITY MA DATE S . MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM�[�j� PLUMBING WORK \I A I^,,,,1 J,t� 1 ( I 0a 3 PERMIT Pf Z 3-6656'// JOBSITEADDRESS 1 (a 0�ti, 3 µ L o r 12 G_ OWNERS NAME f_ °(_."t__ POWNER ADDRESS S`,'"`4 TEL111-S 5 3- ('vS,FAX_ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL E PRINT CLEARLY NEW:0 RENOVATION:E REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO Q 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/OIUSAND SYSTEM - DEDICATED GREASE SYSTEM 7 DEDICATED GRAY WATER SYSTEM __, DEDICATED WATER RECYCLE SYSTEM J-__ DISHWASHER DRINKING FOUNTAIN — FOOD DISPOSER - FLOOR I AREA DRAIN - INTERCEPTOR(INTERIOR) - - KITCHEN SINK - _ - • LAVATORY I . ROOF DRAIN p p` V ��— SHOWER STALL SERVICE/MOP SINK - TOILET I ` - AP 10 2023 URINAL WASHING MACHINE CONNECTION B71 LDIN�DUF-°u i MEN I 1 WATER HEATER ALL TYPES - ,,r WATER PIPING " OTHER - - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY 1E1 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 i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER❑ AGENT 0 SIGNATURE OF OWNER OR AGENT LU 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 will1 all P riinentmrovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /�C / / PLUMBERS NAME LICENSE# 16 3 C . SIGNATURE MP r] JP 0 CORPORATION 0# PARTNERSHIP❑.# LLC 0# COMPANY NAME 461 ^+ ; 0- ADDRESS 6 I`,1 w i3 a S 1-U'-‘ CITY ✓v A r� STATE l•vt I� ZIP D b 3 TE(f 0 3 4 Y-7 `1 P U FAX CELL EMAIL roh k G u r e(.0~7.l 4 1 '., tie /_ 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