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Home My WebLink AboutBLDP-22-004034 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/21/22 PERMIT# BLDP-22-004034 r ,1JOBSITE ADDRESS 132 INDIAN MEMORIAL DR OWNER'S NAME Luke Cyr P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENTS,❑ PLANS SUBMITTED: YES❑ NO❑ FIXTIIRFS 1 FLOORS—, RSM 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 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❑ 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 on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby cavity 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 Thomas Coughlan LICENSE 9629 SIGNATURE MP ❑ JP ❑ CORPORATION Ott PARTNERSHIP ❑# J LLC ❑# COMPANY NAME THOMAS J COUGHLAN ADDRESS 48 HERITAGE DR CITY WALPOLE STATE MA ZIP 020812240 TEL FAX I I CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ID ❑ rtrnasnr FEES$ PERMIT# PLAN REVIEW NOTES /IMP • PACEC 12 . .— • • ' _ _ ' HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r7 • ■ % Mt- ,= t. •- CITY • :r 1 MA DATE / .. _5_,.X j PERMIT# Jr" ' Q0 'D VESS i - 4) h/ M 4/.1 t u b .WNER'S NAME /, i/� r`,' TEL �b g�_37 ' �c7 ' FAX BUPING � -1I1 , " • S -- j TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL D RESIDENTIAL gr , PRINT CLEARLY NEW: 0 RENOVATION: J REPLACEMENT: Er PLANS SUBMITTED: YES ® NO.4 :r FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB �—' E �. L -J �.. � __ . 7-4 CROSS CONNECTION DEVICE ► -� _ ...�� !. _- I,. - - .. =ri DEDICATED SPECIAL WASTE SYSTEM 7 - L-- DEDICATED GAS/OIUSAND SYSTEM - ' . ,_��.-.j DEDICATED GREASE SYSTEM �� DEDICATED GRAY WATER SYSTEM = -- - - ".Man DEDICATED WATER RECYCLE SYSTEM J L. L - J � _ M� DISHWASHER I ----- :•::— ____ ' - l jrTtTT±IiH__ DRINKING FOUNTAIN L .�L—.�.111'--.�— =y�-� — FOOD DISPOSER I_.,...,,.-- !�:_�--., t Y��I __• H. ' L-+- FLOOR /AREA DRAIN 1�, ___ _ iL _ INTERCEPTOR (INTERIOR) - ) �pi2-* - ' --a-mil F. I*1 17,7.,.writ=IS IPTC ..J_-c�'.� KITCHEN SINK �.._r..,�,...�_. -- LAVATORY �� ; _ lI = - J ROOF DRAIN SHOWER STALL L. ! - - 7 i - SERVICE ! MOP SINK WIELIA7-731111ftgall11111MIEMEMMM TOILET i _ —_ ' 1. URINAL }-- ;L.�.__.___j`'. ,._r-j ! jL._.._ -.. ._ WASHING MACHINE CONNECTION 1!�- L.,„...__ IL._. u,L.- := _--_I - WATER HEATER ALL TYPES L J L,-__. ,2 I - WATER PIPING L_L . I,_..._H1:L__1 . I.-.-_�„r. _..� HEflHH ERs __ _ _ _ I ir."--- -_:!_7-__ 7-----ac-gw____7:19_ 1 tial tilli ._ ___4 i ._. rf .r _ 1 w. -_-i y= _ ! a_J Ly ... _.._ J - -I _� .......- -... �,...._ -�� - - - �.. ��. -- _- -. ,.a ,. ,____.1 J 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YE !'4 NO Li , IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY LI 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 on this permit application waives this requirement. CHECK ONE ONLY: OWNER U AGENT U 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 inpompliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4 ! 1 LICENSE # �. \ SIGNA RE PLUMBER'S NAME . I � ? l .— �'�� ', f'1.:.�' .CO�"� �L f+�T,a,��,�, M Jp '�.. • � T CORPORATION#�! [?i2 ;PARTNERSHIP®# �_ 1 LLCO# L__ • COMPANY NAME iftfc -Til,L�r *Ccz U I ADDRESS 30 N tct% + I V a CITY _yi4 STATE M jR— I ZIP D `_ - __,.-I TEL �.. FAX CELL EMAIL M G ' " r) - /i.. , • /' r • 1 (' . 01- , ._ SI/3 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES • Ise 4.7 • r) dro. •