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Home My WebLink AboutBLDP-23-005984 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -�� CITY YARMOUTH MA DATE 4/28/23 PERMIT# BLDP-23-005984 1 IF) _ .., JOBSITE ADDRESS 19 WILDFLOWER VILLAGE OWNER'S NAME RANDALL GLORIA H P OWNER ADDRESS 119 WILDFLOWER YARMOUTH PORT,MA 02675-1474 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 FIXTURES ' 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 2 , ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET _ 1 2 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0 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 an 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 Alan Bishop LICENSE 3t1513 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ELAN W BISHOP ADDRESS 23 DANVERS WAY CITY HYANNIS STATE MA ZIP 026012500 TEL FAX —1 CELL EMAIL alan@awbishop.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 =JEW CITY �(Ar vY,cV • =11- MA DATE 41 2 0 2 3 PERMIT# 2 5') 9 • JOBSITE ADDRESS ‘AJ 1, n.0 - - -r OWNER'S NAME '- - ►c Lt OWNER ADDRESS 1 61 w , 1 u`'t-rU- TELD '5-s2" ' 7 7FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL®' PRINT CLEARLY NEW:❑ RENOVATION REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES 7. FLOOR-0 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 - r DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY :2 '3- ROOF DRAIN SHOWER STALL L. SERVICE 1 MOP SINK TOILET 'L 2 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _ (,) INSURANCE COVERAGE: I have a current Iiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES fa NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POUCYi0 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 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 ' all Peril ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME LICENSE# 11 Si 3 SIGNATURE 71-/ MP❑ JP- CORPORATION❑# PARTNERSHIP El# LLC®'# F COMPANY NAME A.N%.l&,s1,Nu4, 0.,1) r I"1 4-5 ADDRESS 23 Der,v' f . t CITY 1-41 An ,.S STATE .frO ZIP "- co TEL r 6-;) jj TEL ,7.7 `I'S-Cd -9 7 7 FAX CELL `{-s Sal- /7 7 EMAIL A a►, L"' of w 614 �+u , t i;�-►