HomeMy WebLinkAboutBLDP-22-002895 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
yr CITY YARMOUTH MA DATE 11118121 PERMIT# BLDP-22-002895
l' • JOBSITE ADDRESS 50 WARBLER LN OWNERS NAME WOOD JANICE
P OWNER ADDRESS 601 N SPAULDING AVE APT 13 LOS ANGELES,CA 90036-1823 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑
FIXTURES 3 FLOORS RSM 1 2 3 4 5 6 7 8 9 10 11 17 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 SYSTE
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
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❑ NO❑
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❑
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 Michael Mcbride LICENSE 10681 SIGNATURE
MP ❑ JP Q CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive
CITY West Yarmouth STATE MA ZIP 02673 TEL
FAX I CELL I EMAIL stinger.mcbride@gmail.com
g @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
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=s.=i CITY MA DATE f PERMIT# 2Z - 2 �(
JOBSITE ADDRESS __ d-to j - / A OWNER'S NAM `-rq /) f 4Op _
OWNER ADDRESS 07-5Yn Ji ll y if , r4% 'c it TEL[77- .f 7 V fFAX , .
TYPE OR OCCUPANCY TYPE ,vCOMMERCIAL !EDUCATIONAL 71 RESIDENTIAL I.4
PRINT PLANS SUBMITTED: YES ® NO
CLEARLY NEW: ❑ RENOVATION: ED REPLACEMENT:
FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE 1 q-�{� 1.,-I� ,, . ._...if _ -__.II 1. 1,- �y_ 1=_ �.�. ,�...__. _- - 1,: _—
DEDICATED SPECIAL WASTE SYSTEM I _�,1 1.._ 1-7= -1� ...,.,__Lit. - �1- C� --A1 .- ' 1 1�""""3
DEDICATED GAS/OIUSAND SYSTEM _ -u Ii Ii�-=.--1l --� i --_rn--J{�---_.--i .--� _�L_A _ J
DEDICATED GREASE SYSTEM i �_ al „_ =L� -_-- `� - L- ft --,�-. 1-r-,:. - � I_- 1`�.' .�'1�.�. .,_ '(
DEDICATED GRAY WATER SYSTEM z __1i ,___ .� 1 u=— l . - .{ L,JI_-w-•-•x - v J _''
DEDICATED WATER RECYCLE SYSTEM �,� � - - '. _) i �,_,I _ _JL.. �-, -y--1 1—_ � ILi "i
DISHWASHER L. . . - .J � _Ji,., i1, :_ j �a 1. ....:. L� .r..J1=,----111 1
DRINKING FOUNTAIN __�,_��—�,_ �--=r� •--_� - � �--
FOOD DISPOSER I ! �.L1l� -,_, 1���-__1 �D ...r.z. �. �.�--, ;-1. -Y .I-.._ J J
FLOOR /AREA DRAIN I ` ,I--- 1 �._-. ` �� `.�.�-�� - I �a ---�
INTERCEPTOR (INTERIOR) I i! !L J= 1,f=- LL J� i�—_``LE,_1 _ �—
KITCHEN SINK a --d.t._._.,.._'61'4..�� �� ,i � ' ••�.. ,.. .v.4,,�...-. 1_._.�El..�._4_____ . .___„ 1,--
LAVATORY -. II b ,_ - 1 _-_t1„,_1— 1___. �- �I.��L_ Ri_ fl 1__ L.___ 17--)
� . z
ROOF DRAIN L j; _vY L _ _ � JI ___ i
SHOWER STALL --j; _ �-�I�..� . tl ,1=�,—.�. C, II�____JL I t--�
�21 �I � -�-�� 'V-f-� �o-- -i�-Y•.,... -�Al.t �..� .�-:A��-z7. ���t,
SERVICE / MOP SINK 1 �... ><_ Lt,.•.-��s .ti j _ _�` ��— ..�� .}
TOILET - ..� . - - I _r jL - _ L I.. _ ' f1 _.--C�
1, � �� ���.__� `�4 ..� ,�� � ...��.�.....�_L� _, •�.� �
URINAL .�� ` i — 1 1 .1I ... -. !,•..�.. i�..--.1......_,._-�L.., .. _ fL.,. .....i
WASHING MACHINE CONNECTION �_ ,_,_ I! '. ,..,... i—. . i�-�..�.-.. .: .--4. I,-r•,.-_. I _ Ir..--.�,n1 �.�,.°. j.' �. - `.
Ii
WATER HEATER ALL TYPES 1____ �• ._Y....�,.�...kw,La.�Y.- ---, ,4
WATER PIPING ' If �F d jl � ' i' .ii...�._
Ali ' ._....9 ..�...� _._,,.��I���`��n...��i
OTHER _ E ` , �i 1 1 , I I ._1 L., _.I i�,..- I --J L- ?I ___.....1=1.., t _-.J
- -ter_ -._----Rx--i_—1 l s _s- - _I.�-�.n-.l_ Ua - P_• 4 - -}
v s�iL.� -- --+! .•4.-_s. -7.�.�y�iC4._� .caStf 1•� .
{• !a ""�`�"`-����`� + �w� INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES W NO Li ,
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY a OTHER TYPE OF INDEMNITY 0 BOND 0
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 El
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 b in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the G44eneral Laws. . i it \
.JL
PLUMBER'S NAME t „J LICENSE# / /4TJ SIGNATURE
•
MP- JP g CORPORATION D# 'PARTNERSHIP#L LLC O# a
COMPANY NAME', At 4 L M (/1, (►a I ADDRESS A t-c.
CITY • /� n STATE 11f NA- � ZIP () 7 1 TEL ' fit'�D 7l( Z J
FAX CELL l l -� 1 EMAIL --- '' ; / `.
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
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