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Home My WebLink AboutBLDP-21-007351 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY [YARMOUTH MA DATE 6/17/21 PERMIT# BLDP-21-007351 Ktir4„, JOBSITE ADDRESS 35 WHISTLER LN OWNER'S NAME thomas rust P OWNER ADDRESS 75 MORNINGSIDE ST MIDDLEBURY,VT 05753 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El 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 1 ROOF DRAIN SHOWER STALL 1 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 El OTHER TYPE OF INDEMNITY El 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 plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumping Code and Chapter 142 of the General Laws. PLUMBER'S NAME Robert Lalime LICENSE 10701 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME ROBERT C LALIME ADDRESS 575 Main St CITY Mashpee STATE MA ZIP 026492054 TEL FAX CELL I EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEESS PERMITS PLAN REVIEW NOTES •,,.. r mAP : Pfit2e6e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK = n'= ,1Z t PERMIT# L �� - "Z ( _Uv7 3 ti l _� CITY VAR- v U �'I4p vI 1 -I MA . DATE `� /, - JOBSITE ADDRESS 5 if't-` ( 5i-L ER. L nl 1 OWNER'S NAME 're,t^/1. P u s T pOWNER ADDRESS 3 5 /4 t STG Pe 12- L .i i TEL frAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL C' PRINT CLEARLY NEW: ( RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES 1. FLOOR—i BSM 1 2 3 4 5 6 7 8 9 10 11 12 i 13 14 BATHTUB I I ., : _4` 1 1_, __j. , . __... I; ._, - CROSS CONNECTION DEVICE '_. ..__- _. :.,.....1-= i'LY ''- - 1 - --- - - DEDICATED SPECIAL WASTE SYSTEM I__m - . _ - _ i J - AI _ - •1_._ _(� it - DEDICATED GAS/0(USAND SYSTEM �� ,..__ �-_�- �� - -- °..7-.--,�� Awl - DEDICATED GREASE SYSTEM L J L _ - i - LiM - = 'L� DEDICATED GRAY WATER SYSTEM X __ �_. � � _ aWa ! a ; DEDICATED WATER RECYCLE SYSTEM , — -� Mi MIME DISHWASHER _ __ __ 1 _ I _ - -----' PII DRINKING FOUNTAIN I._.__.i I �._._1 - _ FOOD DISPOSERI ,+-_ ' ll11.111 I1I0 ! FLOOR/AREA DRAIN LJ' J - - I. - - 3 INTERCEPTOR (INTERIOR) I iltilli ' 10•1111 •41 KITCHEN SINK M it ' -3 M ' _1 _ _ LAVATORY W L L . . ._a�: I _IL=MME _tJ ROOF DRAIN _ _ 'L_ :' - M _ . .... . 1 `— 1, - � --' 1L j�_ !. e�� is SHOWER STALL (-, ': Fi i .. ,,a_ - -��.-__ SERVICE/MOP SINK _.I_____J'g 7^:`[. -- _ - -- --_...L._ `-�` TOILET — - '}y r,L a+�. r-_ . -.._,1- - — - -. URINALI _ L_ -[_- ._y1 ..�Y i __ �� .Q',. ..�-....,,..y �. _ -.-�._-�,.1.,.,-.-�:_ L tl WASHING MACHINE CONNECTION __ it. ,.o_.._,' - _L _I.�-r-= I . ;:,.--.- L . ..I._ f{.1- _ 71 - _ 'I -.T=. WATER HEATER ALL TYPES / , 1 � 1 11 a _ ' 'I WATER PIPING - -iI 1 9 ___4 :I _1 .....L__ l i—ii 1---linc OTHER �.,.._.....- w..R---Y --}-�-• -- - ---- - -J gi J�P4C = Y s _ . '1 '�- f 1' _ _•1 -_ _ -_ _ I { $ Js � ' �' ii L - I it ,L _ _ _ _ , _ L L- _ ]a J -L. JL L 4L. '1 L-------- T.---,,..„__ ______________.. ____-_ INC _ RIR ... ; litailliLINIMAIIIIIIIiiiiillifinIMILM INSURANCE COVERAGE: i , I have a current liabil yinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES J�F'f"�i�i �� tJT`' 7 NO El j 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I 1.----..._ _ I�t' LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY El BOND ❑ BIJILv sy i 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 an e e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comps' ce with ttinent provision of the Massachusetts State F'I tubing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Lko 6 e `Z- 4 Ci "4-, 6, 1 LICENSE # l 31v/ SIGNATURE • CORPORATION • __. 1PARTNERSHIPL#. . LC - t . aMP� JP® , COMPANY NAME'SAMMO" ADDRESS .5 7 5 CmA( Ai S T • �A MIPIIIIIIIIIIIM CITY • MI11111. STATE ZIP 0 Z 6 ii 6) TEL .5og -- Z-q 2 - ° 31 Y I __ -FAX L 1 CEL I 1 EMAIL • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES r i F 4 f�.