HomeMy WebLinkAboutBLDP-22-007492 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Arcs CITY YARMOUTH MA DATE 6/29/22 PERMIT# BLDP-22-007492
JOBSITE ADDRESS 73 CLEVELAND WAY OWNER'S NAME'SULLIVAN GERARD L
P OWNER ADDRESS SULLIVAN3357 VIRGINIA M 16 TEAL CIR WALPOLE,MA 02081 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW: El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURFS FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 I 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 _
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION _
WATER HEATER _
WATER PIPING _
OTHER 1 _
OTHER DESCRIPTION:septic reroute
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 El OTHER TYPE OF INDEMNITY El 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 John Gough LICENSE 1i0088 SIGNATURE
MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME JOHN B GOUGH ADDRESS 1646 ORLEANS RD
CITY EAST HARWICH STATE MA ZIP 026452146 TEL
FAX CELL EMAIL paces92@comcast.net
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEESS PERMITR
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMI TO PERFORM PLUMBING WORK
T. ' 1 CITY
"';* J ,
MA DATE PERMIT #
JOBSI E ADDRESS � a�u� IC4 (illy OWNER'S NAME C n( 77,6
OWNER ADDRESS791C TEL5-475;2_,W
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL iV
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: D7 PLANS SUBMITTED: YES NO [I
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
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK _ Jcc:..J. YED" `
ROOF DRAIN _
SHOWER STALL JUN 2 9 2022
SERVICE / MOP SINK J
TOILET BUI DING DEPARTME yT
URINAL By - — - - _ _
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
` OTHER
5 )c r-/Qr P,I,A- / —
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES FIZNO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY It OTHER TYPE OF INDEMNITY BOND
� I
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 n
SIGNATURE OF OWNER OR AGENT _
I hereby certify that all of the details and information I have submitted or entered regarding this applica '.n a - true and a curate to e best my ' owledge
and that all plumbing work and installations performed under the permit issued for this application will .e in c., pliance ... th all Pe ent isior .' the
Massachusetts State Plu • o e and Chapter 142 of the eneral Laws.
OY2
/PLUMBER'S NAME �15 LICENSE #/0®� SIGfr&TUR/Pr
MP JP CORP RATION PARTNERS # i LLC a 1 kcO
COMPANY NAM RESS �V 61friA0 T,!.I'6 */4 /411
CITY �fi/0/ 01) STAT ZIP 026* TEL TEL v QLO
FAX CELL W7Y7/7"cf ,? EMAI _i � 9 "19