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HomeMy WebLinkAboutBLDP-23-002457 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/3/22 PERMIT# BLDP-23-002457 i l' JOBSITE ADDRESS 213 SOUTH SHORE DR OWNERS NAME KAMPFE MICHAEL R p OWNER ADDRESS KAMPFE KAREN QUINN 18 SHORE SIDE DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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❑ 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. PLUMBERS NAME William Heath LICENSE 142021 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM 0 HEATH ADDRESS 265 GREAT WESTERN RD 45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat330@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 A. =7 MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK t;!v1 y 42c w>o t-7 MA DATE Vi,v z 242 2- j PERMIT# Z3- 2`1 ' J pi O2• +: ADDRESS 1 I >; Sti o n.,r- S i, (IL,tie-e- OWNER'S NAME /p ci,4 e./ k_4,--►n G BUI DING ` ART ' By__ _ 1lil. :'ADDRESS 12.3 3 S ._ Shen: Oaf 47 TEL 6/7. 573-. 62io FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL Er PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:LrKe PLANS SUBMITTED: YES 9 NOD FIXTURES Z FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB AN 11111 1111111111111111!III 11111111111:im an—__-f'�— .111111111 CROSS CONt�f10N DEVICE —�-—`� �1111111111111 tt)2tl[a;1idmlti;,q r. +LBI DEDICATED MS/OIL/SAND SYSTEM 1111Rui- •- _.__um nannanammiliniin __ DEDICATED GREASE SYSTEM ' ��'MIR DEDICATED GRAY WATER SYSTEM ;-— ,IN gm , 1— DEDICATED WATER RECYCLE SYSTEM . 1, , DISHWASHER '------ - DRINKING FOUNTAIN FOOD SPOSER FLOORD AREA DRAIN .- _Y NITERc PTOR - - BM 1.1111114 NO 11111 AM API 11.-'"" '— KITCHEN SINK XXV ERNE r LAVATORY ROOF DRAIN - SHOWER STALL ill neininiiii R. SERVICE I MOP SINKTOILET iiiiimit _ aus mit URINAL MI 111.15M11110 OW' . M' MN MI WASHING MACHINE CONNECTION11111111•Mill1111111101111N111111111 MINI NIB 1111111111111111111—MB WATER HEATER ALL TYPES -11111111111ii—lilt 11111111111—' WATER PIPING MINI EX 1111111111111101111,III 111111.11111111-111111 MI N F Ell 1111111 111111111 M OTHER INIMIIIIIIIIIIIIIII um � --,ow—1 mit—I Nog iew ma in ma mum 1111111UNKM.R.RRE Il —N—-- Mt OM NW am Elm on limi MK mristlRANGk to hkA cT : t have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142.. YES ErNO 0 F YOU CHECKED YES,PLEASE MEDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UAB8JIY INSURANCE POLICY!J OTHER TYPE OF INDEMNITY El BOND 0 OWNS 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby c erflfy that all of the details and information I have suti mid or entered regarding this application are true and accurate to the best of my Imosiedge and that all plumbing work and installationsperformed under the permit issued for this application wlfl be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Li_- - - PLUMBER'S NAME LW r LA,-.iwIl 141A-I" 3 ;LICENSE#3r LPL/ ! SIGNATURE MPE( JP[Q CORPORATION D#1 PARTNERSHIP Olt LLC[J# COMPANY NAME r3 H" S 6-4At(( Co,„sa n.>c1 1 ADDRESS f V 1" rn.-tr•i .lines T CITY SA..loW. _ 1 STATE I V,,al- ZIP 0ar43 I TELF5"0f 7->6 : /aor I FAX 1 1 CELL y-)'y YY7 iEMA1L '1,//f 6o4-1" 33v 62 �•r,-5'./, C;,1,, 1 2/711