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Home My WebLink AboutBLDP-23-005913 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/25/23 _ PERMIT# BLDP-23-005913 JOBSITE ADDRESS 45 WILLIAMS RD OWNER'S NAME MURRAY JOHN P OWNER ADDRESS MURRAY JEANNE 34 THESDA ST ARLINGTON,MA 02174 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El 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/OILiSAND 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 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 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 Robert Wilson LICENSE#5509 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [OBERT R WILSON ADDRESS 50 LAKE RD CITY WEST YARMOUTH STATE MA —1 ZIP 026733743 TEL FAX 7 CELL 7 EMAIL willidog50@icloud.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -�"i= CITY ate S7 rarer paA MA DATE /`' 14j- PI�RMI ifiZ 3 d 0 5 JOBSITE ADDRESS % /r fah'I S R_p OWNER'S NAME hn ,m,-/rte POWNER ADDRESS TEL FAX TYPE OR OCCUPANC_>TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL®/ PRINT CLEARLY NEW: ' RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14— BATHTUB - CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM _ V DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM - DISHWASHER . DRINKING FOUNTAIN FOOD DISPOSER --- FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK - LAVATORY / - ROOF DRAIN _ SHOWER STALL /' SERVICE/MOP SINK - TOILET URINAL ! WASHING MACHINE CONNECTION 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 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 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 i, Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT III 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 my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' n with all Pertinen ' sion of the Massachusetts State Plumbin Code and� ;C apter 14 the General Laws. PLUMBER' AME gQ LA"' . LICENSE# 1�S U r SIGNATURE MP JP❑ '' / r CORPORATION 0# PARTNERSHIP❑#_/ LLC❑# COMPANY NAME 4-s P/c-ri hY\ 1/4-�n ADDRESS S" � �lv� g0ç5 Riper a CITY penilt 5 STATE/ ' ZIP O64434C / TE FAX CELL77 ( S'J t7 I EMAIL {r✓f I rAS S--) r o✓G , CO in 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