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Home My WebLink AboutBLDP-23-002713 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �,e CITY YARMOUTH MA DATE 11/15/22 PERMIT# BLDP-23-002713 JOBSITE ADDRESS 100 WEBBERS PATH OWNER'S NAME HAAG LISA ANN P OWNER ADDRESS 144 CHAPPAOUIDDICK RD EDGARTOWN,MA 02539 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESD NO❑ FIXTURES t 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 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 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 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. PLUMBERS NAME Joseph Rausa LICENSE 16445 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSEPH A RAUSA ADDRESS 10 SANTO ST CITY 'PLYMOUTH I STATE MA I ZIP 023605250 TEL FAX I CELL I I EMAIL nebathspermits@longhp.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El El FEES$ PERMIT# PLAN REVIEW NOTES , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ',mom, CITY West Yarmouth MA DATE 10/31/2022 PERMIT # '2 3 - 2 7/ 3 JOBSITE ADDRESS 100 Webbers Path West Yarmouth MA 02673 1 OWNER'S NAME Lisa Haag POWNER ADDRESS 100 Webbers Path West Yarmouth MA 02673 i TEL 508-292-2673 FAX — TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES NO FIXTURES 1 FLOOR--I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB —_,, L „ . _ _____L CROSS CONNECTION DEVICE ' 1 _. DEDICATED SPECIAL WASTE SYSTEM i i —_ ________r_ '' 111 DEDICATED GAS/OIL/SAND SYSTEM 'r '' ----1Ls DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _r ' 11 DEDICATED WATER RECYCLE SYSTEM DISHWASHER T_i�. r — �� ._ _ _ _. " DRINKING FOUNTAIN I _ _ FOOD DISPOSER FLOOR / AREA DRAIN I1 li _ INTERCEPTOR (INTERIOR) Ti- KITCHEN SINK T LAVATORY ROOF DRAIN _ SHOWER STALL 1 _I L= SERVICE / MOP SINK I! r it TOILET _ 11 --_�L URINAL I 1 1 l IL WASHING MACHINE CONNECTION r--3 Tr IL L _ _ WATER HEATER ALL TYPES _A_.- - r WATER PIPING — — _IL_ OTHER E I Iti� �: i �L ~__ 11 €�(_ ir-__ -1• 1 r 177 L .. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ! _1 NO [_ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY pi 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 trye�' d a rate t best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corgi ance ith a e nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBERS NAME Joseph Rausa _ LICENSE # [ 13445 —II SIGNATURE MP i JP fl CORPORATION fl#r ]PARTNE HIP f# ILLCE reME3 COMPANY NAME /IA--; 1..;6121Avc--- -71-7-(77---LA____. i ADDRESS • 4 / /_- I .,et f Ai& 6 /1/6 . .. .CITY TO1--W1264, ' II1�II oaf? ,IP TEL ' 774-244-0576 _ STATE �— FAX i 1 CELL ! j EMAIL inebathspermits • longhp.com