HomeMy WebLinkAboutBLDP-22-004262 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
u k,,_.. CITY YARMOUTH MA DATE [1/31122 PERMIT# BLDP-22-004262
IF . JOBSITE ADDRESS 43 COVE RD OWNER'S NAME Cove Island Ventures Ilc
P OWNER ADDRESS 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
CROSS CONNECTION DEVICE 1
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 _ _
SERVICE/MOP SINK _
TOILET _
URINAL
WASHING MACHINE CONNECTION _
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❑ 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 Troy Gilbert LICENSE f9573 SIGNATURE
MP 0 JP 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave
CITY WAREHAM STATE MA ZIP 025711324 TEL
FAX CELL EMAIL lira@coastalphc.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
S
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
~ Yarmouth 1/27/2022
CITY MA DATE PERMIT# •
JOBSITE ADDRESS 43 Cove Road West Yarmouth 02673 OWNER'S NAME COVE ISLAND VENTURES LLC
OWNER ADDRESS 305 UNION S Franklin, MA 02038 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL „ RESIDENTIAL E
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: -V PLANS SUBMITTED: YES ❑ NO ❑
FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE V
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
SERVICE /MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES V
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 [X NO ❑
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [2 OTHER TYPE OF INDEMNITY ❑ BOND D
OWNER'S INSURANCE WAIVER: 1 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.
4% CHECK ONE ONLY: OWNER L AGENT ❑
S ATURE OF OWNER OR AGENT
I hereby certify tha 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
L MBER'S NAME LICENSE # IGNATURE
MP EA JP ❑ CORPORATION L2# PARTNERSHIP ❑ # LLC ❑#
COMPANY NAME Coastal Mechanical ADDRESS 21L Fruean Way
CITY Yarmouth STATE MA ZIP 02664 TEL 508-737-8747
FAX - CELL EMAIL Katherine@Coastalphc.com