HomeMy WebLinkAboutBLDP-23-001327 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
a t/ CITY YARMOUTH MA DATE 9/12/22 PERMIT# BLDP-23-001327
-a ralfm fE JOBSITE ADDRESS 41 JERUSHA LN OWNER'S NAME MCNEILL WAYNE E
P OWNER ADDRESS MCNEILL DOREEN M 29 LANDERS ROAD STONEHAM,MA 02180 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL E
PRINT
CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES El NO El
FIXTURES • FLOORS—. BSM, 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 1 ,
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM ,
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTE
o
DISHWASHER 1 - t
DRINKING FOUNTAIN
FOOD DISPOSER ,
FLOOR/AREA DRAIN ,
INTERCEPTOR(INTERIOR) ,
KITCHEN SINK 1
LAVATORY 1 2
ROOF DRAIN
SHOWER STALL 1 ,
SERVICE/MOP SINK
TOILET 1 2 ,
URINAL ,
WASHING MACHINE CONNECTION
WATER HEATER 1
WATER PIPING ,
OTHER 4 1 - ,
OTHER DESCRIPTION: 1-Ice Make Line 1st
1-Bar sink Bsmt
INSURANCE COVERAGE:
I have a current IiabilitJnsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El 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 El 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 Fernando Coelho LICENSE t,6897 SIGNATURE
•
MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME All Cape HVAC and Plumbing Inc ADDRESS 16 wildwood Path
CITY West Yarmouth STATE MA —1 ZIP 02673 TEL 5083645425
FAX CELL EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yea No
THIS APPLICATION SERVE AS THE 111
FEES E PERMIT#
PLAN REVIEW NOTES