HomeMy WebLinkAboutBLDP-23-006039 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 5/2/23 PERMIT# BLDP-23-006039
JOBSITE ADDRESS 345 HIGHBANK RD OWNERS NAME BORDEAU JAMES C
P OWNER ADDRESS IBORDEAU N E&MOLINA J 19 DEER RUN RD MERIDEN,CT 06451-4918 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑
FIXTURFS 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
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 INSL RANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ 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
PLUMBERS NAME Caleb Maddeford LICENSE 36506 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME [ ADDRESS
CITY STATE I ZIP TEL
FAX —1 CELL 7 EMAIL cmadd19@gmail.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
•
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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` CITY I '1c)()jt'�'1 MA DATE 7'.
v 7 I--;) PERMIT# Bi-I)P 11 - (963`Y
JOBSITE ADDRESS �95 ),ytiV)u,n\A Iaa OWNERS NAME Pck\J ( "A \['1.1.
P OWNER ADDRESS Ph 4 5 H tj
bF--or)v--, '(ZU TEL F
TYPE OR OCCUPANCY TYPE COMM RCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 11i'
PRINT
CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 1 FLOOR-i 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/01L/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 1 MOP SINK r
TOILET J
URINAL
, I WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
— —
i 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 TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY INSURANCE POUCY OTHER TYPE OF INDEMNITY 0 BOND 0
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, nd that my signature on this permit application waives this requirement.
c i
\ CHECK ONE ONLY: OWNER AGENT ❑
SIGNATURE OF 0 OR AGENT
LI-I 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 complianc with all Pertinent pr visio of e
Massachusetts State Plumbing Code and Chapter 142 of t e General Laws.
PLUMBER'S NAME QA \ Mc, e(4(3<' LICENSE#PI✓ 39 5C SIGNATUR
MP❑ JP ` CORPORATION❑# PARTNERSHIP.. ❑.# LLC
COMPANY NAME MGM O d'� U 61 bt n ' ADDRESS ifs) t iC C 1}CS VYT K�
CITY yYY1 co-‘, STATE�N O ZIP a r LI -IA
N�'1 -1 0/
I {� c��0� TEL 7� �7
FAX CELL EMAIL C MCA Q lit Cgrr c 1 ,CCJ VVI
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