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Home My WebLink AboutBLDP-23-006108 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/5/23 PERMIT# BLDP-23-006108 JOBSITE ADDRESS 21 FRANKLIN ST OWNERS NAME DAVID ROGER RICHER OWNER ADDRESS CCROIX DONNA M TR 1119 HARWICH CT ROCKY RIVER 44116-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO m FIXTURES 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING 1 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 El 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 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 matthew coleman LICENSE 314368 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MATT COLEMAN PLUMBING AND ADDRESS 5 college st HFATINP, CITY westyarmouth SIAFE IMA I ZIP 026733792 TEL FAX 7 CELL 9788854343 EMAIL 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 117 CITY toe5 !Ct d'n10 u_('U 1 MA DATE - /�/A % -eke v Z S "e 26 jO =1-E_a # JOBSITE ADDRESS ' 1 F%Ci hGc M S f OWNERS NAME VUV1 h G� LC,Crd rx POWNER ADDRESS a 1 F ail k 1 1 N TEL,OO ✓ I a .-- /YOr*X TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT �,( CLEARLY NEW:❑ RENOVATION:Y REP_ACEMENT:❑ PLANS SUBMITTED: YES [4 NO❑ FIXTURES 7. FLOOR-4 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 y • DRINKING FOUNTAIN FOOD DISPOSER ' FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK i ' i LAVATORY ,. ROOF DRAIN I SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 I R E G E t / D URINAL . ( WASHING MACHINE CONNECTION MAY WATER HEATER ALL TYPES 1i } �� WATER PIPING OTHER BUI _DING DEPATME NT ' Hy - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES t NO D IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY r< 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 I Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT �1 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. PLUMBERS pf( --- NAME? /4 ' ew cd.eV i 6, LICENSE# 3(-13 g SIGNATURE MP ❑ JP[] CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAMEMQ-1-1 co(evil Q11 ADDRESS -- Y(-�U ✓((e e,' 54- CITY JAre54il'L'j(/1` STATE ✓1 ZIP DoZ6'7 5j TEL ` OIIZ77 --`(,1(5 FAX CELL EMAIL i R7as,,l'Od . 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