Loading...
HomeMy WebLinkAboutBLDP-22-002249 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -46Ia CITY YARMOUTH MA DATE 10/19/21 PERMIT# BLDP-22-002249 114 J JOBSITE ADDRESS 4 JOHN HALLS CARTPATH VILL OWNER'S NAME SISSON MICHAEL L P OWNER ADDRESS 4 JOHN HALL CARTPATH VILLAGE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS 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 1 SERVICE/MOP SINK TOILET 1 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. PLUMBER'S NAME jeff ryan LICENSE 1'1068 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 8 russells path CITY marstons mills STATE MA ZIP 02648 TEL FAX CELL 5082803678 EMAIL osandsky@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES c, No THIS APPLICATION SERVE AS THE 0 El FEES$ PERMIT H PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR/OR A PERMIT TO PERFORM PLUMBING WORK CI 10 �_��F- CITY rir� f�J MA DATE l-1 I_ PERMIT# Z2"— z L Li 9 N 2 I JOBSITE ADDRESS 6f SOW //4Z Cl2 V'4 OWNER'S NAME .c��sOi/d/ > , roi OWNER ADDRESS ,c4Aqg'- TEL 2g0 408 FAX 'TYPi F ORS ; OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALL P RUNT :Z LIU JCLE�RL NEW:ElRENOVATION:S REPLACEMENT:❑ PLANS SUBMI 11ED: YES❑ NO a�el 5 , FIXT�IRES FLOOR--4 BSM 1 2 3 4 5 6 7 6 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 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL t _ SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 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 POUCY 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 te 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 e n 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 p' a 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �PLUMBERS NAME e /anQ1v LICENSE e/c967 . SIGNATURE MP❑ JP CORPORATION❑# PARTNER//SSJ,,��IP❑.# LLC❑# COMPANY NAME ADDRESS •/u' � /9971( CITY 444/67 2u5 STATI-f'' 4' ZIP QeG O � �3 7 TEL `r-~ FAX CELL � o 26/6 EMAIL OS•940S /G & . (�