HomeMy WebLinkAboutBLDP-23-8528 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
"= CITY Yarmouth MA DATE 5/16/2023 PERMIT#,& DP-23 $52
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JOBSITE ADDRESS 50 Seaview Avenue OWNER'S NAME Susan Welch&Paul Welch
OWNER ADDRESS TEL 508-839-3612 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL El
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED:YES❑ NOD
FIXTURES 3 FLOOR—. BSM 1 2 3 ! 4 5 I 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOILISAND SYSTEM
DEDICATED GREASE SYSTEM 11111111111111.
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY w
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ROOF DRAIN
SHOWER STALL I
SERVICE I MOP SINK SO
TOILET __ ___—_____
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER Tub/Shower Valve --- _
Shower Valve
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.
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 .it :and accurst o th t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be i 'I.nce with a ertin provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME(Jeffrey K Krula (LICENSE# 15036 (, 1 I NATURE
MPO JP El CORPORATION 3#4383 PARTNERSHIP❑# ]LLCD#
COMPANY NAME Bath Fitter I ADDRESS I25 Turnpike Street CITY West Bridgewater I STATE Ma ZIP 02379 R `C (�
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FAX CELL 508-728-77181 EMAIL lbostonpiumbingI bathfitter.com Z
MAY Zt-61823
BUILDING DEPARTMENT
By'
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