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Home My WebLink AboutBLDP-23-001236 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/7/22 PERMIT# BLDP-23-001236 JOBSITE ADDRESS 44 CLOVER RD OWNER'S NAME JOHNSON KATHRYN J P OWNER ADDRESS TWOMBLY WAYNE A 8 OTTER LN GROTON,MA 01450 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION ❑ REPLACEMENT:0 PLANS SUBMITTED: YES 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 DRINKING FOUNTAIN - - - FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK _ LAVATORY 1 _ ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 - URINAL _WASHING MACHINE CONNECTION WATER HEATER - WATER PIPING 1 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❑ 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 Ryan Storer LICENSE 3i1393 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 35 Chatham Ln 7 CITY Mashpee STATE MA ZIP 02649 TEL FAX CELL 7743683258 EMAIL ry.storer@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES es No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMITS PLAN REVIEW NOTES .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _1�=_- MA DATE 1/ 7/2C.)2Z PERMIT# EP 0 3-)EP TE DDRESS � cLex t-C�1 OWNER'S NAME (i.c 12- 17- rnb'y OWNE D ESS TEL I FAX SUI ING DEPARTMENT TYPE OR TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION: Apt REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-, 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 l , FLOOR/AREA DRAIN l INTERCEPTOR(INTERIOR) v KITCHEN SINK LAVATORY I ROOF DRAIN SHOWER STALL I SERVICE/MOP SINK TOILET I URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING I OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES J NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ig 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 ❑ 1� Z SIGNATURE OF OWNER OR AGENT �l 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 co nce with all P ' nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME rGf l l J- ( LICENSE# �j�'�' SIGNATURE MP ❑ JP;Z CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ADDRESS 3- C iktt ogii, P-Ar CITY Mils 11 '' STATE V*A ZIP CI TEL I_-- ' TEL 74 `3(C/�- -3L Y FAX CELL EMAIL ij. .cin(C a fYic{.`I,- CC (' . 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