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Home My WebLink AboutBLDP-23-000666 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/9/22 PERMIT# BLDP-23-000666 JOBSITE ADDRESS 135 NORTH MAIN ST OWNERS NAME REDMAN E SCOTT P OWNER ADDRESS 1332 AMOSTOWN ROAD WEST SPRINGFIELD,MA 01089 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL m PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES CI 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 1 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❑ OWNERS 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. PLUMBERS NAME Michael Mcbride LICENSE'10681 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ny- FEES$ PFRMIT# PLAN REVIEW NOTES rr MA. AC-IUSETTS UNIFORM APPLICATION FORA P,ERMI TO PERFORM PLUMBING WORK �; vl, ® •2`3— 0 � ,4E TI=�' U u ` MA DATE PERMIT# I 5 SI A DRESS 13 5 il,/Be �rt-4t /vi q, j OWNER'S NAMES CC' c' 114'ft f�_ PULL DEP,> (1 RESS > / Y —IR- tit TEL y7 �e FAX TYPE OR OC Y TYPE COMMERCIAL❑ ED ATIONAL ❑ RESIDENTIAL(Xt PRINT CLEARLY NEW:❑ RENOVATION:[ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ , ;—; 4 f-A q.-,- FIXTURES 1 FLOOR-i BSM 1 2 3 4 5 6 7 B 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 SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY / . ROOF DRAIN ' SHOWER STALL / —' SERVICE/MOP SINK { TOILET / i URINAL f . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER I ' ' 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 [Y- 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 l' Massachusetts General Laws, and that my signature on this permit application waives this requirement. • 1-. CHECK ONE ONLY: OWNER El AGENT ❑ SIGNATURE OF OWNER OR AGENT �l 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 LICENSE#I?&77. SIGNATURE MP ❑ JP Ki CORPORATION❑# PARTNERSHIP❑.# / / / LLC❑# COMPA Y AMEr\k (13. r I P t"`'tf- ADDRESS 7 raId LA LAC CITY `'T Al S STATE VIA' ZIP V L-61 / TEL 7 y YI e 712 FAX CELL EMAIL k i r• A, L it l (Qv y<yM4/L ', m 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 •