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Home My WebLink AboutBLDP-22-002335 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10122121 PERMITS BLDP-22-002335 JOBSITE ADDRESS 43 COGSWELL PATH OWNER'S NAME GILLESPIE CHARLES F P OWNER ADDRESS GILLESPIE MARTHA E 43 COGSWELL PATH WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO El FIXTURFS FLOORS—. RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:tub/shower valve INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND El 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 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 Jeffrey Krula LICENSE MA SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑s LLC ❑s COMPANY NAME Bath Fitter Bridgewater ADDRESS 25 Turnpike Street CITY West Bridgewater STATE MA ZIP 02379 TEL 5085212700 FAX CELL 5087287718 EMAIL 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 11:11F=35 CITY �Gbr"MO MA DATE / ~Z % — z 71 PERMIT# u L O P-L`t- I O 3 JOBSITE ADDRESS ZZ_ (,"0 h gel. OWNER'S NAME Deb V IIle; / POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ E ATIONAL El 12� PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT: DU PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR—I 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 SYSTEM DISHWASHER DRINKING FOUNTAIN " FOOD DISPOSER 1 . FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK — — LAVATORY ROOF DRAIN SHOWER STALL SERVICE!MOP SINK - ---- TOILET - # .„ 0 URINAL WASHING MACHINE CONNECTION 1-AN 2 9 i WATER HEATER ALL TYPES i_ T WATER PIPING BUILDING ,,,tit` ' - OTHER INSURANCE COVERAGE: ,� I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L'1 N0 ❑ IF YOU CHECKED YES, PLEASE INDICATE THETY E 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 i. Massachusetts General Laws,and that my signature on this permit application waives this requirement. `rt 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 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 Pero ent vision the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � Q � PLUMBERS NAME LICENSE# »/6 Y SIGNATURE MP"JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ('.3 vl um 10I4 C/ 4- lt1 11/.7ADDRESS 7v`�X Z2 CITY O d til / STATE Y14A- ZIP 6-1,67.E 3 TEL FAX CELL ,525&—, -f"/ '/36 EMAIL C.b()loll bin c% 13 t0 L% 'tit ea/4 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