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HomeMy WebLinkAboutBLDP-22-004415 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 3i CITY YARMOUTH MA DATE 2/8/22 PERMIT# BLDP-22-004415 l JOBSITE ADDRESS 143 HIGGINS CROWELL RD OWNER'S NAME MAGUIRE JANET M P OWNER ADDRESS 143 HIGGINS CROWELL ROAD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El FIXTURFS FLOORS—. RSM 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/OIUSAND 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 - - 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 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 El 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 Matthew Hyland LICENSE 36776 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'MATTHEW HYLAND ADDRESS 127 COPELAND ST CITY BROCKTON STATE IMA ZIP '023016958 TEL FAX I I CELL I I EMAIL lhylandhvac@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 El FEES$ PERMIT# PLAN REVIEW NOTES I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 M ',w CITY ' S i.__ __ AR,�..o�T H . - s_ MA DATE 7. 7 ; PERMIT# 7- Z Z-t --< < 1_ JOBSITE ADDRESS 1Lit kl ,,n� L fq,„),,Li21 - _.] OWNER'S NAMEUA A ja vIULf OWNER ADDRESS i___ _ .._ _ _ . . = TELi , O -77 ' 716 j FAX1 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL D RESIDENTIAL Eri PRINT CLEARLY NEW: L RENOVATION: 11 REPLACEMENT: PLANS SUBMITTED: YES J NO ,,,,- FIXTURES -1 FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB �— '.__,, _ CROSS CONNECTION DEVICE --i-___-- . —..-- ji— .=11ft= -3.--- lw.., ____ (--_...__ __-- DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM ! _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM - ( DEDICATED WATER RECYCLE SYSTEM - DISHWASHER ...�..... , - .-: - DRINKING FOUNTAIN - _ __ -1 I _ FOOD DISPOSER . _ ... , Y-_. .... 1 FLOOR I AREA DRAIN 1 INTERCEPTOR (INTERIOR) -okkr. KITCHEN SINK ��_ -_ ._ � - .<�. .� --- , LAVATORY _ -- 11111111111 ROOF DRAIN ._. ....._ _ -� �:M IA. � ' . , = SHOWER STALL �_ f .ill I SERVICE / MOP SINK _ .�.._ —_ ._ ._ II w' ,I IIIIII TOILET -a-mworamemition _ ....__ ( -_--- - URINAL ___ M_ r111',y WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _ _ = Ri __� WATER PIP NG MK - _-- ERifOALAixelal&,,„..72fhitiLaill- --- -_ OTHER t , �- . _ �. _ ►•ter'._.._.. _ _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES/NO l IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY g 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 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 an acc a to the best of my knowledge and that ail plumbing work and installations performed under the permit issued for this application will be in compli a it Pertinent provision of the Massachusetts State Plurnbing Code and Chapter 142 of the General Laws. r� -- ' - -- PLUMBER'S NAME ['�1.�v� -_ _.N, �,f�rl�,.., :_.____ _ _ 'LICENSE # 33 7 7Co / SIGNATURE MP JP[ ( CORPORATION # PARTNERSHIP #1 ,� ._.•_ LLC©# _ COMPANY NAME('(�'&A M _ UAL 1 ADDRESS �—Co1Q., , _ .K _._- _ 1 1, CITY N0 o c et„ 1 STATE MA ZIP Oa3 TEL !— 6 (- w FAX z... CELL EMAIL4LV" C ✓ G_ • . rv� .__ _ I C CC- - bcC1 c 0 r