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Home My WebLink AboutBLDP-21-001582 #8 S- i,4 i/'N c L.z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK `' ;? CITY YARMOUTH MA DATE 9/25/20 PERMIT# BLDP-21-001582 . -� JOBSITE ADDRESS WILLOW ST %e el-4 a,!c OWNER'S NAME IYARMOUTH CAMPGROUND ASSOC C/O LEE W ERICKSON TREASURER 455 QUINAPDXET ST JEFFERSON,MAtNC TEL P OWNER ADDRESS I 01522-1461 TYPE OR OCCUPANCY TYPE COMMERCIAL E RESIDENTIAL ❑ PRINT CLEARLY NEW El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO❑ FIXTURES -: FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 . SERVICE/MOP SINK TOILET 1 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 INSLRANCE POLICY El 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 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 William Woods LICENSE#1887 SIGNATURE MP El JP El CORPORATION D# L I PARTNERSHIP ❑# LLC ❑# COMPANY NAME EILLIAM T WOODS ADDRESS PO BOX 702 CITY W BARNSTABLE STATE MA ZIP 026680702 TEL FAX 7 CELL Ai 31,? S'j S( EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMITS PLAN REVIEW NOTES bernoH mAP .' PAR c E c : • So I-Ic MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK V -'�=C CITY I Alf4)Uf „ MA DATE4/).Vli'Ll PERMIT# ,E2i/ P--c?1-DDI b--N-a - y � t h . 1. JOBSITE ADDRESS 'ev_., .� �C a__ OWNER'S NAME....,k L� � p OWNER ADDRESS l TEL i TEL --- !FAX TYPE OR OCCU PANCY TYPE COMMERCIAL ED EDUC ONAL RESIDENTIAL ID PRINT PLANS SUBMITTED: YES ® N0� CLEARLY NEW: El RENOVATION: LI REPLACEMENT: FIXTURES -1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I.,_____., /17-1EDL IL. . - LJ ._.,-:....._I�.._T:J .p-.I_ F-jL_.._-J L J CROSS CONNECTION DEVICE i___,,�.�,,.�,X- ;l�,r,,,Tsj .s: - 1 - _ _ , .j, _J DEDICATED SPEC AL WASTE SYSTEM ,�.. �r=,_ �. 3��._ � -� -- 1 Y�� DEDICATED GAS/OIUSAND SYSTEM —�1 a �_.S �- I -�-� — `� -k` ��`� � DEDICATED GREASE SYSTEM vyI.' _ 1 ._ J_-- '! -l'' ---_`�. -- i`�'_"` I-- - 1—--- 1 SY DEDICATED GRAY WATER STEM I-----IJ_ i_ ._ 'i _ 11 _ Ai jr-_ z1-� . . 1_Jl_�J- I �- DEDICATED WATER RECYCLE SYSTEM ([ - :-_ JI .__ Ji _ji._ -- t i. --n - - ---1,— ',-=B" I.,- DISHWASHER L - - -- L=_____ =_ ... _1=ii ''—._.__ L_..,-ail , .,,—-.] - _ L.,_, J_J — � fir-- DRINKING FOUNTAIN 1 _- -1L... i A.771. ! =L _ __ a.� 11. I�.._ „_,� d ,.. „.„ FOOD DISPOSER L®,,,1 . r J 1I rs_ .„„ IL-�,�. 1^_.1(.�-�:II ,� 1.___A _._,11, t__ _.. I FLOOR 1 AREA DRAIN -I k__H - - __IL, 0_ ._--_i)„,___S .. ....._ --1- - - _— . INTERCEPTOR (INTERIOR) 1_. ,. I ; = —,t=i- 1 - __ L . � �.J KITCHEN SINK 4L _�L.�.��..-�i1_', ! t_ �....,�.�,' �-11 - LAVATORY i'-�-f--_-�'L,7 =_JI . 11___1=1I L - -R?r �- r 1-- r �, _ ROOF DRAIN '--1 'i-- ti. 1 . _, 7_ 1 i.____. !. �I--.-t' l .a r�.... ].-_-- SHOWER STALL _ �L Ii .er �i 't� ,J Ji,�..�...,=.I. IL l i SERVICE 1 MOP SINK L_ L_ r 11 .„di _J!__1,�- .11..-___L.. 1 I,_.mJI, - TOILET !-1 1 . Jl._-..,._..ilk _.� , }I _ L i _L ji,�._-T ' i L am... _ Il . URINAL �—�WASHING MACHINE. CONNECTION 7-1Th-----71, . �y_- i _= :..,n �— .,...-___ r. ,,, , •��-=_- -�-}=i WATER HEATER AL_TYPES j _' - !'6 - '' ` --,_.1':. , ,. i, . -. l�.w;.. Ii.._ . _. L�-...,.�. .=...d _� 1 _ �1�------�,. ,I--— '11. WATER PIPING ! OTH ER L _ 5 i, _ 1 ITT.I _- 11__..=,.�,1 I 1, 1 f ..�_ IL _,i _r L� _i. _�..I L L=:_._ _e�i r,...s�= g L:=carT��.�. ,_._ice 1 < i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES L±4 D . IF YOU CHECKED YES, PLEASE INDICATE THE,TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i t S^ LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ElBOND LI 1 SE is 2 ? 2 \C ii does not have the insurance coverage required Chapter 142 of the v OWNER'S INSURANCE WAIVER: I am aware that the licensee9by U Massachusetts General Laws, and that my signature on this penmt application waives this requirement. CHECK ONE ONLY: OWNER LI AGENT LI 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 Pertine t pr vision of t e Massachusetts State Plumping Code and Chaptier 142 of the General Laws. 4/1/41 /1 '. ElillPLUMBER' NAME Vi>400________._ /�LICENSE# J SIGNATU E MP JP fl CORPORATION •,..'I.#-'� _ PARTNERSHIP®#L_ ___ �W.j LLC LI# _ 0 COMPANY NAME ie " , r' S 40/(imt-61 ADDRESS po � _ _ 4 CITY JSTATE IWAVN ZIP .....0.424.t.. ._ J TEL FAX 'l - V-(131 CELL 3 e2 r .5181 EMAIL /d*i0N /C CO tom! I 3 ' ')".}-) ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES •f)