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Home My WebLink AboutBLDP-22-002920 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ CITY YARMOUTH MA DATE 11/18/21 PERMIT# BLDP-22-002920 it JOBSITE ADDRESS 34 WILLIAMS RD OWNERS NAME Jessica Bassett P OWNER ADDRESS 34 WILLIAMS RD WEST YARMOUTH,MA 02673 TEL J TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT 0 PLANS SUBMITTED: YES NO❑ FIXTURFS FLOORS—s RSM 1 2 3 4 S 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I urn 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 Matthew Gray LICENSE 304752 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COUNTRY WAYS P&H ADDRESS 1197 Tremont St CITY Duxbury STATE MA ZIP 02332 TEL FAX —I CELL EMAIL matthewgray77@gmail.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 mAssAct-WETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ ��(�(MQUV MA DATE 11 IS PERMIT# • L= CITY - _ ,1. � = SITE ADDRESS 3L1 � \ \OAAS 1� OWNERS NAME Twy t 3e55lco, V?mstTf JOB SITE OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMER ❑ EDUCATIONAL ❑ RESIDENTIAL V PRINT PLANS SUBMI I I ED: YES❑ NO❑ CLEARLY [ NEW: ❑ RENOVATION: REPLACEMENT:12 -FIXTURES 1 FLOOR-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM . DEDICATED WA I EH RECYCLE SYSTEM DISHWASHER .1 . DRINKING FOUNTAIN " FOOD DISPOSER , FLOOR/AREA DRAIN , INTERCEPTOR(INTERIOR) 9L KITCHEN SINK L �. " YT i -4 y LAVATORY 1- I . 1 ' ROOF DRAIN NL 6,SHOWER STALL I' SERVICE I MOP SINK TOILET ( (. j�niyG Oil,PAR I MENT' URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER . INSURANCE COVERAGE: I have a current liabiliWnsurance policy or its sutastantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑ IF YOU CHECKED YES,PLEASE INDICATE Ty E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 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. 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 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 n 'th FjS " ent e Massachusetts State P,umbing Code and Chapter 142 of the General Laws. PLUMBERS NAME/' LICENSE# SIGNATURE MP❑ JP Ef CORPORATION❑# PARTNERSHIP # Lc❑# T C COMPANY NAME I(�I UO�S _ ADDRESS ((q 7 I?i e�OAf S I- CITY I l�I0tkrL STATE k/ ZIP 00-3.5'0-- TEL 75/ Shy g63- FAX CELL EMAIL Afk 1.6 6r‘a/ 77g 6/"1 I. "Alt. CSC 1H fSU 4-Ns.