HomeMy WebLinkAboutBLDP-23-003433 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY [YARMOUTH MA DATE 12/20/22 PERMIT# BLDP-23-003433
}_ JOBSITE ADDRESS 7 FRESH BROOK RD OWNER'S NAME Brian Davis
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OWNER 4DDRESS TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑
FIXTIJRFS FLOQRS 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 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER
WATER PIPING
OTHER
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current liability inst,rance 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 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 of this permit application waives this requirement.
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 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 [Michael Mcbride LICENSE*681 SIGNATURE
MP ❑ JP El CORPORATION ❑# I —� PARTNERSHIP ❑# LLC ❑#
COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive
CITY West Yarmouth STATE MA ] ZIP 02673 TEL
FAX 7 CELL EMAIL stinger.mcbride@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
�'- 6. L-( -i 6 ` I'� MA DATE PERMIT# 3 -- . 3.�
t`-- '�_��,�_ CITY �:
OWNER'S NAME
f'.. - � et ill �� ��� � � �U�. ��/J � r 1-1) 0 �, Li l.�
/ i 2 �r
f / OEcp ) ,O S OW NE ADDRESS Z�i )TEL �7 ��,1 0 7 2 U FAX
18Uit_- irTYPE OR Z�O Gj1CUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL a)
L '3Y i
PRiNk rti J
Ct: - ___ lIEWI❑ RENOVATION:El REPLACEMENT: a PLANS SUBMITTED: YES® ' NO[
FIXTURES 7. FLOOR-* 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 SYSTEM
DISHWASHER •
DRINKING FOUNTAIN
FOOD DISPOSER ,
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) ,
KITCHEN SINK
i
LAVATORY , / - i ,
ROOF DRAIN
SHOWER STALL / .
SERVICE/MOP SINK
TOILET f
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 POLICY [y, 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 ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
LU 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. I / / ; 1/4.__'
PLUMBER'S NAME M I'1U LICENSE# SIGNATURE
MP❑ JP 11 , CO PORATI�ON❑# PARTNERSHIP❑.# / / LLC Of
COMPANY AME 1.7.J I t (r� )� I ADDRESS 7-- 1 V''L( lI ✓L. '
CITY ,1 L1 C7 /7 1 5 STATE i' ✓t ZIP G Z / TEL D-d 7/Z
FAX CELL EMAIL 5 i-- /1) +/Y/ Cil ''1‘J2-e' 470444 - (6'-
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