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Home My WebLink AboutBLDP-23-003884 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITY YARMOUTH —1 MA DATE 1/17/23 PERMIT# BLDP-23-003884 JOBSITE ADDRESS 8 HARBOR RD OWNER'S NAME Timothy Bryan P OWNER ADDRESS SOUTH YARMOUTH,MA 02 664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION: icemaker INSIJRANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ 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❑ 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 pe-mit 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 Joshua Brunelle LICENSE 32314 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSHUA A BRUNELLE ADDRESS 69 GOVERNOR BRADFORD RD CITY BREWSTER STATE MA ZIP 026312805 TEL FAX CELL I I EMAIL brunelle9806@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Ye No THIS APPLICATION SERVE AS THE ❑ ❑ FEES E PERMIT# PLAN REVIEW NOTES MASSACHUSETTS-UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -Taw . CITY/TOWN of _ MA DATE ///3/z3 PERMIT # JOBSITE ADDRESS D lu>s:c-loc c OWNER'S NAME i KO—f i,--)(6..,L__ p . OWNER ADDRESS c( - '.TEL 7 '- .? O4/"6 = FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL [ '. PRINT CLEARLY NEW: RENOVATION: [ REPLACEMENT: I I PLANS SUBMITTED: YES NO FIXTURES 1. FLOOR--4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 - BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIA_WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM , , . DEDICATED GREASE SYSTEM • DEDICATED GRAY WATER SYSTEM . DEDICATED WATER RECYCLE SYSTEM . . DISHWASHER r . DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR) . _ KITCHEN SINK . LAVATORY • . ROOF DRAIN • SHOWER STALL . SERVICE 1 MOP SINK. . TOILET • • URINAL • WASHING MACHINE CONNECTION . WATER HEATER ALL TYPES WATER PIPING OTHER . •T L2._,C-, . NA4C,---,.., ‘ INSURANCE COVERAGE: I have a current liabiliyinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ; NO ^ IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 7 BOND — OWNER'S INSURANCE WAIVER: I am aware that the Iicensee 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 [ I 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 co lance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .� PLUMBER'S NAME S4S1t- -‘.) l e_ .LICENSE # i 3 2-31 SIGNATURE i MP JP [ ,- CORPORATION LI # PARTNERSHIP # _ LLC — # COMPANY NAME JO$4- is ,,..a -- ( & 't6( IJ ADDRESS X 9 f /-scs lv‘: CITY 3 cc'S -cs- STATE WL°� ZIP 0 2-63 ( TEL 771- ? --0 FAX CELL EMAIL �k-NDk.c�J-e 49,istC& CS arI ,C'O G+2 fe+'i