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Home My WebLink AboutBLDP-23-004934 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w) i&r CITY YARMOUTH MA DATE 3/8/23 PERMIT# BLDP-23-004934 k:°E ; JOBSITE ADDRESS 11 WHIFFLETREE RD OWNER'S NAME JEFFERY BURKE P OWNER ADDRESS 19 FRAM DRIVE MANSFIELD,MA 02048-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL E 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 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 INS JRANCE 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 plumLing 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 Chris Poire LICENSE r091 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME POIRE PLUMBING HEATG& ADDRESS 51 St. Joseph Street CXY11 INC; CITY Hyannis STATE MA 7 ZIP 0261-0000 TEL 7748366461 FAX CELL 7 EMAIL mcplumber26@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES - — . \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i_I=:7• -MA DATE .7- .- -<:f PERMIT# Z 3 C G'y f � 1 R 0JO SITE ADDRESS I I w I - 1-2 t �'Z�,� OWNER'S NAME J"e J3 c�r OWNER DRESS TEL i 6 l 7 85 y `1/1O FAX BOIL NC DEPARTMENT BYTYPE OR----OCCUP_ANC" PE COMMERCIAL if EDUCATIONAL ❑ RESIDENTIAL Pi PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES T FLOOR—* B5M 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ' I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM i DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) I KITCHEN SINK LAVATORY ROOF DRAIN I SHOWER STALL --__, SERVICE/MOP SINK TOILET �_ URINAL . 1 WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0`NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER' SURA WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massa tts eral Laws t my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT D- SIGNATUR F OWNER OR AGENT ..1 I hereby certify that aII of t 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 compli e wi all Perlin provision of the Massachusetts State Plumb' g Code and Chapter 142 of the General Laws. PLUMBER'S NAME 't Pt--5 O LICENSE# L 3:3 0 j S ATURE MP In JP Er CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME_ �— H C ADDRESS 57 5,-.,iti CITY STATE M4 ZIP CG�66 / TEL FAX CELL 7 ?Y L 5 c %6.7 EMAIL 71" /i t/17 Zrw--- —e Ci-1511-1-4". } ROUGHlapjlat PLUMBING}INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES