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Home My WebLink AboutBLDP-23-005836 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK rj:: + kCITY 'YARMOUTH MA DATE 4/20/23 PERMIT# BLDP 23 005836 :i JOBSITE ADDRESS 344 FOREST RD OWNER'S NAME AMY OBRIEN t1 P OWNER ADDRESS 344 FOREST RD SOUTH YARMOUTH 02664-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL. El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES i FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 2 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 INSLRANCE POLICY❑ OTHER TYPE OF INDEMNITY El BOND El 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 plumb.ng work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State P umbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Timothy Mcelroy LICENSE 1;5993 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [TIMOTHY M MCELROY ADDRESS 70 Cranberry Highway CITY Sagamore STATE MA —I ZIP 02561 TEL FAX —I CELL 7 EMAIL tim@capecodmasterplumbers.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 iJ " MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK P !Tr/) q / 3E13 - 005f3CITY l a_ r YYL.6 IA t-1--> MA DATE pt.d1JOBSITE ADDRESS 4-1 'I Y— OWNER'S) OWNER ADDRESS T L NAME V 1 V") �' 317 -S 5 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: ; REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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 I, _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) 1 KITCHEN SINK I, LAVATORY ;), ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _ OTHER l G ltir�R( }'16 i l _ pvk,srd-A.c r S Vu Vv- -r INSURANCE COVERAGE: 111A 0 I have a current Iiability_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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all o'the details and Information 1 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 NAMETA✓v-'tYt j YV1-ce L Y C LICENSE# i S 6-13 SIGNATURE 7T MP JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAMED .. L r, d ,it.s: frc r P 1 t ti,w‘h-t vS ADDRESS 73 L'Y a. i-"t. rtn,�, t Jl CITY ,Ca.IN C N r — STATE YVIA ZIP 5 L I TEL l5O a l ? " 5 �l s FAX CELL EMAIL tAina &1 o GUY✓` APR 2 0 2023 BUILDING DEPARTMENT •.1,