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HomeMy WebLinkAboutBLDP-21-002301 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =f=4 CITY YARMOUTH J MA DATE 10/27/20 PERMIT# BLDP-21-002301 JOBSITE ADDRESS 2 GREYHAMPTON RD OWNER'S NAME POWERS MEGAN R P OWNER ADDRESS 2 GREYHAMPTON RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES -i FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 • BATHTUB CROSS CONNECTION DEVICE 1 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 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❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INS JRANCE 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 Plumbiig Code and Chapter 142 of the General Laws. PLUMBER'S NAME Douglas Langtry LICENSE 1#1305 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [Douglas P Langtry ADDRESS 1268 ROUTE 28 CITY S YARMOUTH STATE MA 7 ZIP 026644459 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 T YARMOUTH 10/19/2020 PERMIT # ,t CITY — - - — — MA DATE ‘70-1" 2 GREYHAMPTONROAD MEGAN POWERS JCBSITE ADDRESS OWNERS NAME JOVVNER ADDRESS SAME TEL 781-910-8588 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL f EDUCATIONAL RESIDENTIAL U PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ■' PLANS SUBMITTED: YES NO n FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 _ DEDICATED SPECIAL WASTE SYSTEM T DEDICATED GAS/OIL/SAND 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 / MOP SINK __ J TOILET URINAL WASHING MACHINE CONNECTION - _ WATER HEATER ALL TYPES 1 _ WATER PIPING OTHER INSURANCE COVERAGE: I have a current Iiabilit Linsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [I] NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ill OTHER TYPE OF INDEMNITY I I 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 SIGNATJRE 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 accurat to th best of my knowledge and that all plumbing worts and installations performed under the permit issued for this application will mp is e with a Perti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME DOUG LANGTRY LICENSE # 11305 GNA RE MP JP■ I-1 CORPORATION # PARTNERSHIP # LLC E] # 3081 COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28 -- -- --- - ' CITY SOUTH YARMOUTH MA _ STATE ZIP 02664 TEL 508-619-3367 FAX 508-619-3367 CELL EMAIL DOUG-AQUA©COMdAST.NET1 9 (1 2U2U BUILDiN' Di 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 I'