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Home My WebLink AboutBLDP-23-001791 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � •y, 6 CITY YARMOUTH MA DATE 1014/22 PERMIT# BLDP-23-001791 • 1' JOBSITE ADDRESS 697 WILLOW ST OWNERS NAME WALSH JOYCE M LIFE EST p OWNER ADDRESS 697 WILLOW ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—, RSM 1 7 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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❑ BOND Cl 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 COREY SIBBIO LICENSE 34795 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME I ADDRESS 7 GLENEAGLE DR CITY CENTERVILLE STATE MA ZIP 02632 TEL FAX CELL 5086854605 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 _1 .1M g' — a ft== R IliC C r?-1 MA DATE /L /4// , P- PERMIT# Z3 - I `i/ "JO ITE DDRESS 1 l IA, ,86,24, .s rfrof i /4 t l}&-- OWNER'S NAME .Tv y c e _yv 1:1S AI f 0C 4 2L2 W R DDRESS 5/ /4 f,::. TELSG53.gV_i`/Li FAX B IL4NOS ADRAR uOady NCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL i]CLEARLY NEW:[ RENOVATION: NI REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOXJ FIXTURES 1 FLOOR-, BSId 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 , —y DEDICATED WA--ER RECYCLE SYSTEM DISHWASHER I —� DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY �� ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET 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 V NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �l OTHER TYPE OF INDEMNITY ❑ BOND LI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Massachusetts General Laws, and that my signature on this permit application waives this requirement. • Z. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L1•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 Perlin provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. / �j/ �L .,c PLUMBERS NAME CG)2 r v j i I.;g iC LICENSE# P/7.5--. SIGNATURE MP❑ JP( CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME (_ic4 E y S i (WC,' ADDRESS ) 6 4 eA.%4 yet- ()Jc CITY 0 e/-fish. 4, , !/T STATE%I/ it ZIP CSC Z. S,� TEL $cv69s" 4465- FAX CELL S H/9 e EMAIL 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