The URL can be used to link to this page

Home My WebLink AboutBLDP-2-003599 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/3/23 PERMIT# BLDP-23-003599 JOBSITE ADDRESS 88 SILVER LEAF LN OWNER'S NAME DOHERTY BARBARA TR P OWNER ADDRESS BARBARA DOHERTY FAMILY TRUST 88 SILVER LEAF LN WEST YARMOUTH, MA TEL 02673 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ 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 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/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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY❑ 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. 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 Richard Olsen LICENSE 1a0335 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 Hokum Rock Road CITY Dennis STATE MA ZIP 02638 TEL 5083855290 FAX CELL EMAIL OFFICE@OLSENPLUMBING.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 . ' .4111, .' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R F `1'u _ 4__E _ - , MA DATE a PERMIT # L.3 3 __ gu t. TY u\ > \ ctcrnO 1h 0� yI2 DECL � 2022 JC BSITE ADDRESS g j S dyer _ISM . (c OWNER'S NAME 2 _._ p OWN:' ADDRESS . _ _._ ___ _ ._._. TEL� — FAX BUILDING E. AR f MENT w: _ am-13 -3ia - •ANCY TYPE COMMERCIAL 1 EDUCATIONAL RESIDENTIAL X PRINT E� CLEARLY NEW: RENOVATION: REPLACEMENT: D. PLANS SUBMITTED: YES ❑ NO13 FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB --- Ii CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIVSAND SYSTEM i DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM j DISHWASHER 1 i DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN — . INTERCEPTOR (INTERIOR) KITCHEN SINK _".- --s ._........ rw..e '-�._ _;: LAVATORY ROOF DRAIN <k SHOWER STALL ` . - - SERVICE/ MOP SINK TOILET URINAL WASHING MACHINE CONNECTION ___ WATER HEATER ALL TYPES WATER PIPING OTHER __.: __._ _- - --r________+.- _ -= ' _ __, _ _ _ _____ _ . 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 1 , 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 L _ 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 'knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' i e wit r''Pe,rtinent ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME [RICHARD OLSEN _LICENSE # M10335 SIGNATURE MP v JP j CORPORATION# 2166 PARTNERSHIP(# LLC0# I COMPANY NAME L OLSEN PLUMBING & HEATING ADDRESS ( 357 HOKUM ROCK ROAD _ CITY DENNIS STATE i MA ! ZIP 102638 TEL 508-385-5290 ____I FAX 508-385-6963 CELL i 1 EMAIL