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HomeMy WebLinkAboutBLDP-23-003337 • • 4=4- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/15/22 PERMIT# BLDP-23-003337 t' JOBSITE ADDRESS 20 CENTERBOARD LN OWNER'S NAME David Maloney P OWNER ADDRESS 20 CENTERBOARD LN SOUTH YARMOUTH,MA 02664-1004 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES z 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 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 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. 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 Kevin Abbey LICENSE#2357 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ABBEY PLUMBING&HEATING ADDRESS 596 Queen Anne Road CITY Harwich STATE MA ZIP 02645 TEL FAX 5084308462 CELL 5083670437 EMAIL abbeyplumbing@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES =: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CIT MA DATE 5,• )S PERMIT# DEC �JeB 'AD R SS Q (s j coca L L OWNER'S NAME IAA Lo4 L'i i /)4 it /� 8 OWNER A S TEL FAX I t�IN, UtI-HK b K--- E COMMERCIAL 0 EDUCATIONAL ( J RESIDENTIAL[l CLEARLY NEW:D RENOVATION:[/ REPLACEMENT:C PLANS SUBMITTED: YES 0 NOD FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB N! M�: i�� Imo: �.- - INK __ CROSS CONNECTION DEVICE �' ; DEDICATED SPECIAL WASTE SYSTEM z' �'��.( I „In f ' DEDICATED GAS/OIUSAND SYSTEM I 1 1 4 I DEDICATED GREASE SYSTEM ( � L 4 DEDICATED GRAY WATER SYSTEM � i�9 _( lm I t_ DEDICATED WATER RECYCLE SYSTEM 1111111.1111111111111mmiciiiiignignwasmilliMmt DISHWASHER i I 11111.11111111f!W Mit DRINKING FOUNTAIN MAI ,� ' : FOOD DISPOSER _ __IMP JLR. --- ---Si FLOOR/AREA DRAINx I I INTERCEPTOR(INTERIOR) ji �( , I _ KITCHEN SINK r 'i r ;.aili aliei MEM 1 ; LAVATORY L�- ION I ! -.; ROF DRAIN SHOWER STALL "FilliWilliirMMEMFONIMINIUMI_ M-.,.iMOMMAW 1 -___ SERVICE/MOP SINK i , I INIIII _ _. 1 _ it , ', _____ TOILET aii,' , i i , r URINAL M __ Ain WaC® 1,__ IL WASHING MACHINE CONNECTION Imo, f 01111111 IMINIIIIi WATER HEATER ALL TYPES ( ___ 'i 10111M, L . WATER PIPING I PIM 1 I I ' OTHER . . MIN i 'i1 UM IMOMIIIIIIMIIIIII S.N:MK �' M ' 1 Mi/MI IMI -01iiii_ EM!RESIIIIMIningliii INSURANCE COVERA E: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES"NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY' " 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 [AAGENT Ell 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 .nd 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 co... e with e• provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �y PLUMBER'S NAME LS✓.)J M`z LICENSE# 113 57 SIGNATURE MP2/ JP: CORPORATION o#r-- IPARTNERSHIPD#r I LLC[j#[ __ _- COMPANY NAME Q ADDRESS 1�° ax. rti ipL Rc.00 __. CITY • - ,C rl STATE rid I ZIP y 5 i TEL C Z Cif FAX ( CELL I 1 EMAIL IPle7at fair✓t Pa✓il/C 1 C/}S�*.11/e1