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Home My WebLink AboutBLDP-23-004079 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK En_�� CITY YARMOUTH MA DATE 1/24/23 PERMIT# BLDP-23-004079 JOBSITE ADDRESS 2 VIRGINIA ST OWNER'S NAME DonnaThompson P OWNER ADDRESS 2 VIRGINIA ST WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL CI PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESE 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 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability iinsurance 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❑ 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 Charles Fremault LICENSE#1863 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CHARLES R FREMAULT ADDRESS 24 WOODLAWN AVE CITY WALTHAM STATE MA ZIP 024511810 TEL FAX CELL EMAIL crfreemault@gmail.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK rw5ii nu_5 CITY y :4.'C/�-�c� ,<� MA DATE - ;•j.- i PERMIT # Z 3 4/079 JOBSITE ADDRESS 2 vr,< 6 ' 44 -;XAK,,e-r— 1 OWNER'S NAME ,gc►,.A-'4 7-2,c',y7' 5 c._`" POWNER ADDRESS 7 5R 6,2 TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: L REPLACEMENT: L PLANS SUBMITTED: YES I/ NO FIXTURES Z FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB J y , U U 11 Ii U I CROSS CONNECTION DEVICE ( _ 1 11 U 0 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM i DEDICATED GRAY WATER SYSTEM _ _____. f IL_, 1000 ll II DEDICATED WATER RECYCLE SYSTEM Ii [, U DISHWASHER I dIJ U DRINKING FOUNTAIN J FOOD DISPOSER r 1111.11.M11.1111 FLOOR / AREA DRAIN MIONWMM� �I�, -_ INTERCEPTOR (INTERIOR) KITCHEN SINK J L LAVATORY ROOF DRAIN 1 SHOWER STALL / y I SERVICE / MOP SINK I I -- `- f TOILET IMINAIIIIIMM\ICI MOM 111111111.1 OM I IMI IMO URINAL WIIWII I i ird[7 i�� WASHING MACHINE CONNECTION MM�i�I�OM WATER HEATER ALL. TYPES 1 ILDI I •I ART WATER PIPING i , �� OTHER MWIIMIMI IMIMILIMINIIIIIIMINg 11 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 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 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 permil 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 I G'//A,cC. J .f rwAif+ily". r4I- 1LICENSE # Nryikr J SIGNATURE MP / JP ❑ CORPORATION '#r jz...>- ]PARTNERSHIP #1— LLC 1# --mac. . 1ADDRESSr , ,..;c.:. ,_..,.,.,-„, ... . COMPANY NAME P"./.--,"<d-,..7.14./cr-- �AY/7, < f .� /� ��y CITY 4 c, ,4 ;i/.4�1 STATE -? ZIP c)e C :/Si TEL 7a, -ey.5,9 -,,*.z? -e___ --- FAX i i CELL EMAIL G�,z.,/,t', '7,-,;e' <;-''r-? c- , c 0,--1-1 1