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HomeMy WebLinkAboutBLDP-22-003566 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/28/21 PERMIT# BLDP-22-003566 JOBSITE ADDRESS 27 PLYMOUTH RD OWNER'S NAME HAMILTON LEE M P OWNER ADDRESS 27 PLYMOUTH RD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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/OIUSAND 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 r 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❑ 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 Richard Olsen LICENSE 10335 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD P OLSEN ADDRESS PO BOX 2026 CITY DENNIS STATE MA ZIP 026385026 TEL 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 0 FEES$ PERMIT# PLAN REVIEW NOTES P MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Tter► c, — i?i3 C .;I�'M burn port MA DATE ILI(►'1 LI PERMIT# 'Z1- J.�` r JOBSITE ADD RESS 21 pILlynourn t(octc i OWNER'S NAME 1>Pe hctmtitor 1 6 t 4R ADDRESS J TEL C)U1 u 1 'JCI C FAX BIJ11[EErOR-, RiXeilfflAld0Y YPE COMMERCIAL 0 EDUCATIONAL D RESIDENTIAL a CLEARLY NEW:jam., RENOVATION:❑ REPLACEMENT:rr► PLANS SUBMITTED: YES❑ NOT] FIXTURES 1- FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 E, t 1. ---- ;q r----?� CROSS CONNECTION DEVICE I. , T VII�t DEDICATED SPECIAL WASTE SYSTEM , 1 WIi, DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM Ijig� f 1 DEDICATED GRAY WATER SYSTEM EIRINIMINIMIWIL all , I DEDICATED WATER RECYCLE SYSTEM �l�;i ;Ij I� � I DISHWASHER OURS.opaiipipepaialimpinn DRINKING FOUNTAIN ii ` FOOD DISPOSER II ,ff ' FLOOR/AREA DRAIN jan ,, INTERCEPTOR(INTERIOR) RR lair PM Mr MIMI . KITCHEN SINK I � LAVATORY ;����'i� �, � � _ NS ROOF DRAIN I i . II I SHOWER STALL ;_ 1j ;1 10_, SERVICE/MOP SINK pa TOILET r URINAL f li I` WASHING MACHINE CONNECTION ? ; WATER HEATER ALL TYPES ^[ , WATER PIPING OTHER i 1 I I i1`' i _,7 F 11 I 1- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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. CHECK ONE ONLY: OWNER Li 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.1..— nowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' a wit e ' enton of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ ��� PLUMBER'S NAME RICHARD OLSEN LICENSE# M10335 SIGNATURE MP JPD CORPORATION[# 2166 PARTNERSHIP❑# LLCL# COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 HOKUM ROCK ROAD CITY DENNIS STATE MA ZIP 02638 TEL 508-385-5290 FAX 508-385-6963 I CELL EMAIL