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Home My WebLink AboutBLDP-23-002770 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/17/22 PERMIT# BLDP-23-002770 11 JOBSITE ADDRESS 3 HARBOR RD OWNERS NAME NELSON CHARLES J P OWNER ADDRESS NELSON BEVERLY S 22 NORTHERN AVE BEVERLY,MA 01915 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS t 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 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 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. PLUMBERS NAME Charles Nelson LICENSE 9/172 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME Charles J Nelson ADDRESS 22 NORTHERN AVE CITY 'BEVERLY I STATE MA ZIP 019152B41 TEL FAX I I CELL EMAIL n ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El El FEES$ PERMIT# PLAN REVIEW NOTES M �,� • r/1 AS ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l� '` .�=a .__ ._CITY._ , y (\i 7, 'TT I l- MA DATE i 1 )a`. PERMIT# 'Z�-- 2? 7° -1 v 17J202I-E DIkESS 3 l.-kt� V_Ise)C\VN R3) OWNERS NAME l.Q4f1 e S K.4 1 BUP'NG DE • PESS ' Y4 nAF_.. TEL4'17 ze5i&Fi-- % — --- PE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL. PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENtcr PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _—_H DEDICATED GAS/OILISAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM — DEDICATED WATER RECYCLE SYSTEM DISHWASHER I DRINKING FOUNTAIN _ _ _ , FOOD DISPOSER , FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK l _ LAVATORY ROOF DRAIN SHOWER STALL _ _ SERVICE I MOP SINK ' TOILET - _ URINAL . j WASHING MACHINE CONNECTION _ i 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 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 j Massachusetts General Laws,and that my signature on this permit application waives this requirement. _� Cd-S Q. Ak, CHECK ONE ONLY: OWNE AGENT ❑ SIGNATURE OF OWNER OR AGENT 11 '! 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. �' 1 � / l nn �/ �1 -&G`L PLUMBERS NAME �.he-1 (e J 9_ 5r9Y& LICENSE# 1 g�G SIGNATURE MI JP El CORPORATION❑# PARTNERSHIP❑.# Rd LLC❑# COMPANY NAME ��l� ft. -4� b Y ADDRESS -Z' 14i-4^ r�6G CITY Y�! v I C)t Jr/l STATE/k. ZIP 2_(% 7,� ~T-EL � V U 1`115C-in L.C) CELA/ E- 6 )6r�'69 EMAIL tribe ,(::i. ,{�J,5 Ai -. C�GA 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