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HomeMy WebLinkAboutBLDP-23-005531 L " MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w _ ` CITY YARMOUTH MA DATE 4/5/23 PERMIT# BLDP-23-005531 rn F JOBSITE ADDRESS 1 /J 0 So Up/ OWNER'S NAME GILMORE JOSEPH P OWNER ADDRESS 4 DORESETT DR EAST WALPOLE,MA 020320000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: m RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO m FIXTURES 1 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 4 6 _ ROOF DRAIN SHOWER STALL 2 5 SERVICE/MOP SINK _ 1 TOILET _ 3 5 URINAL WASHING MACHINE CONNECTION 1 1 WATER HEATER _ 1 WATER PIPING OTHER 8 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES m NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY m OTHER TYPE OF INDEMNITY 0 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. PLUMBERS NAME Timothy Sullivan LICENSE 12846 SIGNATURE MP © JP ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME TIMOTHY E SULLIVAN ADDRESS 1102 HANOVER ST T SULLIVAN MECH INC CITY HANOVER STATE MA ZIP 023392043 TEL FAX CELL EMAIL jen.medairos@outlook.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES • Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMR# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ., ; FaL7P-23- O 55 C = 1, - CITY 5Uu`41 MA ,DATE '41312)03 PE # • J. /SD so /j/ 5 JOBSITE ADDRESS 5.7AR r1Uu-l-h OWNER'S NAME j o 1)Cs':\mote P OWNER ADDRESS 1 t i ,_�.(tc11(4 lc. TEL 17=t)4- 60023 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:II RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES1 NO 0 FIXTURES 7 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I _ CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER -I _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN _ INTERCEPTOR(INTERIOR) KITCHEN SINK 1 . LAVATORY 14 .Le ROOF DRAIN SHOWER STALL a. ' S SERVICE/MOP SINK I✓ TOILET 3 5 URINAL Lam* WASHING MACHINE CONNECTION-3oK 1 1 WATER HEATER ALL TYPES I WATER PIPING OTHER (Ar(. al t0P-xt-i-e-->3 I . "Da 0.5P 06, rF,cc3oAer 1 du+c5ide StIcocl4, , 4 . ice!lass--lA Iles i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES K NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 11 OTHER TYPE OF INDEMNITY 0 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. CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application -.- true and ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will • co p'an with all rtin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , PLUMBER'S NAME S('°h i•AkbY`''`' UCENSE# 1al4to IGNATURE MP `J JP 0 CORPORATION # PARTNERSHIP 0# LLC 0# COMPANY NAME 1-Su\)\vim m in.P. l It e.,a, nc ADDRESS 110 g -i nov-ecz s, LAn,7 Pi- CITY 4(10-e1L STATE �� ZIP O' 339 TEL ?'6 I -k'7%- g -n FAX -1gI-$-)i-SLi9ft CELL EMAIL J an,Pleaat.ro a, Ou+luoY,c4