HomeMy WebLinkAboutBLDP-22-001094 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 8/26/21 PERMIT# BLDP-22-001094
JOBSITE ADDRESS 1101-5232 HEATHERWOOD OWNER'S NAME HEATHERWOOD CONDO MAIN
P OWNER ADDRESS C/O DORCAS MCGURRIN 100 HEATHERWOOD YARMOUTH PORT,MA 02675 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El
FIXTURES • =LOOKS 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
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK 1
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 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 James Parkhurst LICENSE 13223 SIGNATURE
MP ❑i JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME JAMES P PARKHURST ADDRESS PO BOX 6273
CITY Plymouth STATE MA ZIP 023626273 TEL
FAX CELL EMAIL jparky317@yahoo.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPUCATION SERVE AS THE ❑
FEESS PERMITS
PLAN REVIEW NOTES
CID- APPLICATION#
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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(7L CI r�/a, .i f I MA DATE PERMIT#
y JOBSITT p0 ADDRESS � /7% . ;A-nud OWNER'S NAME )Je4 E c4.-i`,,e 1 /e.,, �c-/:4-
OWNE ADDRESS ,/ /t7 /000 6,r/vylc � _.1'/i TEL FAX
TIP OR <OO( UUp CY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑
F _
C lV ' RENOVATION:REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-' 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/OIUSAND 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 l MOP SINK / ,
TOILET / ' '
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
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 v NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY R 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 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 compliae with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1
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PLUMBER'S NAME . - K+L/t vt'-;-r- LICENSE# f 52,2> _�''
7'/,4SIGNATURE
MP F4 JP❑ CORPORATION[ # s ,� PARTNERSHIP❑# LLC❑#
COMPANY NAME I �ia,,,zk�.-(.'/z-",r— r, if ADDRESS PO ( -X :; .?7 2)
CITY (/i�, y 0 , STATE 1l� ZIP ' Gam. 3 C., .2. TEL 5:,:, `f>5' 0 ,,.
FAX / CELL EMAIL 7 -t e- /K 3, 7 t /AJ1 c% - c '.."1-
THIS APPLICATION SERVES AS THE PERMIT YES NO FEE:$