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HomeMy WebLinkAboutBLDP-23-002443 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w '£. CITY YARMOUTH MA DATE 11/3/22 PERMIT# BLDP-23-002443 • 11_ JOBSITE ADDRESS 29 VALLEY RD OWNERS NAME PARKER EDWARD P TR n OWNER ADDRESS THE EDWARD P PARKER TRUST 29 VALLEY RD WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:ice maker feed 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 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 Troy Gilbert LICENSE 18573 SIGNATURE MP 0 JP 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherine@coastalphc.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 .,-.a..virw.i. x = `_ CITY Yarmouth MA DATE 11 /01 /2022 PERMIT# 2"3--- 2- f Ll 3 JOBSITE ADDRESS 29 Valley Road OWNERS NAME Kings Enterprise LLC 1 OWNER ADDRESS 24 Namaschaug Landing Spofford NH 03462 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL f l EDUCATIONAL RESIDENTIAL ti PRINT CLEARLY NEW: n RENOVATION: V REPLACEMENT: PLANS SUBMITTED: YESV NO [-] FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE _ 1 DEDICATED SPECIAL WASTE SYSTEM _ _ DEDICATED GAS/OIL/SAND SYSTEM _ _ DEDICATED GREASE SYSTEM . DEDICATED GRAY WATER SYSTEM _ _ DEDICATED WATER RECYCLE SYSTEM 1 _ DISHWASHER 1 . DRINKING FOUNTAIN _ . FOOD DISPOSER FLOOR/AREA DRAIN I l INTERCEPTOR (INTERIOR) I4 _ KITCHEN SINK i 1 f I LAVATORY ROOF DRAIN SHOWER STALL _ - SERVICE / MOP SINK _ TOILET URINAL WASHING MACHINE CONNECTION 1 _ . WATER HEATER ALL TYPES I . WATER PIPING Water Line To Fridge 1 OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142, YESV NO ll IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE OF INDEMNITY ,_ BOND LI 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 n 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / �/��� PLUMBER'S NAME Troy J Gilbert LICENSE # 13573 NATURE MP`' JP ❑ CORPORATION ❑ # PARTNERSHIP # LLC V# 4350 COMPANY NAME Coastal Mechanical ADDRESS 21L Fruean Ave CITY S. Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX _ CELL EMAIL Katherine@Coastalphc.com