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Home My WebLink AboutBLDP-22-006297 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ilfmitrtpj CITY YARMOUTH ] MA DATE 5/2/22 PERMIT# BLDP-22-006297 <- rrF JOBSITE ADDRESS 79 WHITE ROCK RD OWNER'S NAME WINGATE KIRKLAND REAL ESTATE P OWNER ADDRESS 20 LINNELL LN YARMOUTF PORT,MA 02675 LW TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL D PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 2 2 ROOF DRAIN SHOWER STALL 4 SERVICE/MOP SINK 1 TOILET 1 3 URINAL WASHING MACHINE CONNECTION WATER HEATER 4 5 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current IiabilitJnsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILIT'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 requiremert. 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 31umbing 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 William Woods LICENSE#1887 SIGNATURE MP ❑ JP ❑ CORPORATION ❑4 PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM T WOODS ADDRESS PO BOX 702 CITY W BARNSTABLE STATE MA ZIP 026680702 TEL FAX CELL EMAIL adadsl0@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES E PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __ .CITY /,4„,,i1at1 1(7 MA DATE S . ._ PERMIT# Z Z - (` L (i 7 JOBSITE ADDRESS 79 .--1-)hi e Xock OWNER'S NAME hs /�k C o wi ei POWNER ADDRESS TEL 568 36,) 3 79 ' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D/ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:[jam RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO Et"' FIXTURES 7 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ■■ 1111 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED AS ■� �■■■■■■■■�� DEDICATED GREASE SYSTEM 11111111111 DEDICATED GRAY WATER SYSTEM __ — DEDICATED WATER RECYCLE SYSTEM 111111111111.1 DISHWASHER --__—_--_-- DRINKING FOUNTAIN FOOD DISPOSER ❑❑ ❑❑❑❑❑❑.�■■� FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) __ _____--____■ KITCHEN SINK j LAVATORY I PM Ell ROOF DRAIN —Bill --___Imuniam ull SHOWERS / �■❑❑��■ . SERVICEE!MOP MOP SINK 1111121111111161 TOILET MOM -- —� MI�. t■�_ URINAL �— ___C_11•1�� ' 111__ j WASHING MACHINE CONNECTION _— _____"I��®Mj WATER HEATER ALL TYPES ill ❑❑❑❑❑ ■■ 1 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 Pr NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY'INSURANCE POLICY Y' 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 c 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/li' with all Perlin nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /�Gi / PLUMBERS NAME'G" 1 kiOcIS LICENSE# 1/te 7 . SIGNATURE MP JP ❑ CORPORATION E# PARTNERSHIP❑.# LLC❑# COMPANY NAME ^1)/1-Z5 /L e4 /l�I1 ADDRESS ' / 'X R2 CITY/A/7L -6 /t/__` !e _ STATE -� ZIP Oa2Tp41 TEL,`-(�._3 7 FAXSDF 37 Sn CELL 57 _3 2 35-S(J EMAIL .5-/ k7 / 100 "t' dSS tit) 1- a5- t 161; — 1) 30 aJ 0 0 V w i a .❑ z >a O � z co ¢ a w W � O 0 Pct U a. a. ces LLA 2 W 0 z 0 H U Ch z x . 0