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Home My WebLink AboutBLDP-23-004240` . --- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK a CITY YARMOUTH 1 MA DATE 1/31/23 PERMIT# BLDP-23-004240 JOBSITE ADDRESS 3 HUMMOCK LN OWNER'S NAME GARBITT APRIL J P OWNER ADDRESS 3 HUMMOCK LN YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL EI PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El 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 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❑ 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. 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 plumb ng 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. PLUMBERS NAME Albert Perry LICENSE 26791 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [LBERT J PERRY ADDRESS 10 HERON CIR CITY MASHPEE STATE MA —I ZIP 026493418 TEL FAX —I CELL 7 EMAIL ajpplumbingandheating@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES E PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -at— " CITY ��K /n t7��d/�(7x — __ { _ MA DATE I �rl PERMIT# z 1>Z°/U JOBSITE ADDRESS 3 Pt U(k)/i't v C K.- C-,/" OWNERS NAME el-PA 11-- G 4 R(( 7(1 POWNER ADDRESS 3 pi U.n7/,--) D C-k_ L A) - TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL(' PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:E PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - CROSS CONNECTION DEVICE — DEDICATED SPECIAL WASTE SYSTEM I H DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I _ DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY ROOF DRAIN ' SHOWER STALLk SERVICE/MOP SINK I F °' V 11 TOILET i URINAL s i iA N j /U2' WASHING MACHINE:CONNECTION i - 4 WATER HEATER ALL TYPES # BJILDING DE DART Ern- . WATER PIPING L,; OTHER — 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 INDICATIATHE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY d 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 1 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'..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,a Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. G� G/�j --' PLUMBER'S NAME A L& ( . . i°i`2 R.1 112 LICENSE# 2�. I. GNATURE MP ❑ JP(] CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME. j-L P C')(7-2`i' P( u(''2 I )6 A P !f( T7 J6 ADDRESS I Q K<-a'u C 7/7 c L c— CITY m 0(2 --7 STATE /)-`A ZIP 0 2 6'''T ? TEL S 05 6gi '- ?I 7cl FAX CELL:::- '6s' . c.?(-7 EMAIL ajpl°iV�.b l,)q c"n 4 h<6.76.17i 7/ccL^uo . co i 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