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Home My WebLink AboutBLDP-23-003258 Montabello MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK W_w- CITY YARMOUTH MA DATE 12/12/22 PERMIT# BLDP-23-003256 tl— JOBSITE ADDRESS KINGS CIRCUIT OWNERS NAME GREEN OAK HARBOR INC P OWNER ADDRESS 46 GLEN AVE NEWTON,MA 02159-2066 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m 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 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 WATER PIPING OTHER 1 OTHER DESCRIPTION:demo water line 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 Michael Mcbride I LICENSEI1A681 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@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 CITY /qc -,. F6/2d r 7— MA DATE Z PERMIT# 2 may_ JOBSITE ADDRESS i/41)5 S / &Lit' 64 OWNERS NAME 04/77 3 L O s POWNER ADDRESS &/ K%h5 1 CiYc, 7` 77V TEL 7_103 -//]Z�` FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ M �IDE�TIA n (52G PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER r - C I 1 . FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1 KITCHEN SINK DEC 09 9 2022 LAVATORY ROOF DRAIN BUILDING DE[-ARTM-NT SHOWER STALL ey ` SERVICE!MOP SINK ' TOILET URINAL T _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER c1_p p c 7- 5 — INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY.K 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 .l 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 Plluumbingl.Code and Chapter 142 of the General} Laws. PLUMBERS NAME 1 JI L1rtc(e L np Vu rl SLe 7 f �'` LICENSE# � SIGNATURE MP❑ JP[ CORPORATION❑# PARTNERSHIP❑.# P ra 1 ' LLC # COMPANY NAME IPA( � C' 444- ADDRESS ?)7 f! ci,VvlI•'7 4(J'P CITY � �'� c STATE PA— ZIP 074() I TEL FAX CELL77`/ / 71 7 Z EMAIL n-1-/if)\ 0,—..41 v3r cea 01,4)-) ` • (A 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 1 i 1