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Home My WebLink AboutBLDP-23-004434 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK !kW, CITY YARMOUTH 1 MA DATE 2/10/23 PERMIT# BLDP-23-004434 .- JOBSITE ADDRESS 122 EXETER RD OWNER'S NAME Ryan Bickerton P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESE NO❑ FIXTURES FLOORS—• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIA_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 4 ROOF DRAIN _ SHOWER STALL _ 1 SERVICE/MOP SINK TOILET _ 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 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❑ NO ❑ 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 Ryan Bickerton LICENSE 1i806 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# • COMPANY NAME [RYAN M BICKERTON ADDRESS 19 MANILA AVE CITY HYDE PARK STATE MA —I ZIP ,021361410 TEL FAX CELL 7 EMAIL ryanbickertonplumbing@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMITS PLAN REVIEW NOTES ti L' I G" ` fMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 1_f=--': crE EyrULA MA DATE aI Ir�S PERMIT# JOBSI A.PRESS c� E�p 4-c( tr OWNER'S NAME fp 09 L ER AD'IRESS TEL FAX BUILDING tl'W r3Y TYP_E_Of ___ laUUMR-N� TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL[ - P R!' -- CLEARLY NEW: 'fii RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO la— FIXTURES 7 FLOOR—+ BSM 1 2 3 4 5 6 7 8 j 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM L DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER. FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL ,/ SERVICE 1 MOP SINK TOILET a URINAL j WASHING MACHINE CONNECTION ,/ WATER HEATER ALL TYPES WATER PIPING OTHER I �INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Eric ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EK 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 �:l 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 plumbirg work and installations performed under the permit issued for this application will be in co liance with all Pertinent provision of the Massachusetts Sta:e Plumbing Code and Chapter 142 of the General Laws. I n PLUMBER'S NAM= 2yG 1 LICENSE# 93CX..g SIGNATURE MP Elz JP❑ CORPORATION❑# PARTNERSHIP Ell LLC❑# COMPANY NAME 1- I(_i/•_( ADDRESS cdccf V tom, /I` `' — t-> c -F CITY, t-c STATE M}1 ZIP O U Cc C, TEL �S 1- sc FAX R CELL EMAIL Ric,„ 4 ct fz,,,QLvyi , _ I-- an"It`_., 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