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Home My WebLink AboutBLDP-22-003569 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLOP-22-003569 1 JOBSITE ADDRESS 39 GLEASON AVE OWNER'S NAME GOULART TERESA P OWNER ADDRESS GOULART RUDOLPH 39 GLEASON AVE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 FIXTIIRFS FLOORS RAM 1 2 3 4 fi 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILJSAND 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 liab insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 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 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 Christopher Murphy LICENSE 16548 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'BLUE BEAR PLUMBING ADDRESS 1100 Corp Park Dr,Ste 1740 CITY 'Pembroke I STATE 'MA I ZIP 102359 I TEL 17817064682 FAX 1 1 CELL 1 1 EMAIL 1 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES$ PERMIT# PLAN REVIEW NOTES , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ~ y. ;; �LJ' ,vac -rim�-A mouth MA DATE 112/13/21 ' PERMIT # 2 Z 3 CT(0 9 LJQ SITE 1DDESS 39 Gleason Ave OWNER'S NAME'Rudy Goulart 1 EC 20 Dili OWNER 4DESS [39 Gleason AveaU TEL 508-776-4232 FAX IL DING DEPARTMENT ly PE_OR----, CY YPE COMMERCIAL EDUCATIONAL RESIDENTIAL i,. T CLEARLY NEW: RENOVATION: _.w; REPLACEMENT: v PLANS SUBMITTED: YES NO FIXTURES Z FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB NM - i -- - ----' CROSS CONNECTION DEVICE r DEDICATED SPECIAL WASTE SYSTEM i - _ DEDICATED GAS/OIL/SAND SYSTEM L JU' DEDICATED GREASE SYSTEM Li.-- - I I. ' la DEDICATED GRAY WATER SYSTEM -? 1I . I DEDICATED WATER RECYCLE SYSTEM Lj �( j DISHWASHER - DRINKING FOUNTAIN L _ I FOOD DISPOSER ' `MEI wan FLOOR / AREA DRAIN MIN IIIIII ell.0.1 M'11111MMIIIIIIII INTERCEPTOR (INTERIOR) 111MMIlliiiii. Ina KITCHEN SINK MI Miff -4 11111111111 LAVATORY r - r miumirmorwriniMIIMINIFINIFIlit ROOF DRAIN ;WM Eli ME MIMI OM'MIMI INIF SHOWER STALL L___ s IIER SERVICE / MOP SINK ERIBIBRII M TOILET 1 I URINAL 1 -' j _ ! --, i F r 111 t WASHING MACHINE CONNECTION �,,_.. A _ 1I i1 WATER HEATER ALL `YPES 1 I ---1,- I ! WATER PIPING OTHER L.. iiPlict_ma'. Imo NNE Immo lam umilliMill111111 INSURANCE COVERAGE: I have a current Iiabiliinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES EJ NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v 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. CHECK ONE ONLY: OWNER i AGENT j 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, rv' h II Pert' en prdvision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I PLUMBER'S NAME Christopher Murphy LICENSE # 16548 SIGNATURE MP - JP CORPORATION 'S # 4301 IPARTNERSHIPIJ# LLCD#1 COMPANY NAME Blue Bear Plumbing , —I ADDRESS [100 Corporate Park Dr., Ste 1740 I CITY Pembroke STATE MA J ZIP 02359 TEL 1781-706-4682 I i FAX f� , CELL r781-783-2414 EMAIL info@bluebearplumbing.com r r