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Home My WebLink AboutBLDP-21-000160 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7113/20 PERMIT# BLDP-21-000160 JOBSITE ADDRESS 71 KATES PATH VILLAGE OWNER'S NAME BEACH DONALD REX P OWNER ADDRESS BEACH LINDA S 71 KATES PATH VILLAGE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 12 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO FIXTURES'1 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/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 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY❑ BOND❑ OWNERS 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 certiy 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 26383 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME TROY J GILBERT ADDRESS 39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK tit:ie, CITY Yarmouth Port MA DATE 07102/2020 PERMIT# L1)/0'o// -era 044 JOBSITE ADDRESS 71 Kates Path OWNERS NAME Rex Beach POWNER ADDRESS L.S..ame —1 TELI }FAX r _-1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED. YES NO FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB kaiak CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIJSAND SYSTEM DEDICATED GREASE SYSTEM _ -. 1.. DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM , DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 11 KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK M TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING _ OTHER 1 r 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. 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j� 1` _ PLUMBER'S NAME Troy Gilbert LICENSE# 13573 ,' SIGNATURE MP, , JP CORPORATION❑#[ PARTNERSHIP®# LLCLd#.4350 COMPANY NAME[Coastal Mechanical I ADDRESS 21 L Fruean Ave ____j CITY'South Yarmouth STATE MA I ZIP [02664 1 T ,rjezer .` { Ill. FAX , CELL L5p8-850-6955 EMAIL Ilisa@coastalphc.com w �0" 1 SUL 13 ? j BUILDING DE A..R } nr ,.J