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Home My WebLink AboutBLDP-23-003611 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK el CITY YARMOUTH MA DATE 1/3/23 PERMIT# BLDP-23-003611 JOBSITE ADDRESS 221 CENTER ST OWNER'S NAME GREENHOW SEAN P OWNER ADDRESS GREENHOW LAUREN 51 ALEXANDER AVE BELMONT,MA 02478-4807 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES 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/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 1 WATER HEATER 1 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 OLSEN PLUMBING&HEATING ADDRESS 357 Hokum Rock Road CITY Dennis STATE MA ZIP 02638 TEL 5083855290 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 R F g41,, . SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK s — tom—-: CITY Yc\( %)m (t MA DATE �Z�22�2,"Z PERMIT# �B ITE DRESS �A centcr st�rezt OWNER'S NAME BUILDING NA R rOWNR DDRESS TEL FAX TYPE OR OCC NCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL' PRINT CLEARLY NEW:❑ RENOVATION:1F REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOE FIXTURES Z FLOOR-, BSM 11 I 2 3 4 5 6 7 I 8 9 10 11 12 13 14 BATHTUB I # - 1 e CROSS CONNECTION DEVICE , DEDICATED SPECIAL WASTE SYSTEM ( 1111� E 7----- Mil DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE I I DEDICATED GRAY WATERTER SYSTEM Ina EMI DEDICATED WATER RECYCLE SYSTEM E m —, ` gn DISHWASHER ' I MI111111111111111111111111111111N11111111011111" ._ DRINKING FOUNTAIN [ 4, 1 - I- w 1 FOOD DISPOSER FLOOR/AREA DRAIN 1 ti INTERCEPTOR(INTERIOR) 1. I l r 1 KITCHEN SINK �, �_. . k �._ -_ t LAVATORY ROOF DRAIN 1 I �. SHOWER STALL Ali ) SERVICE/MOP SINK 1 TOILET ?. - �_ ', _ - -.6, 4 URINAL WASHING MACHINE CONNECTION ! M i, j, , ' WATER HEATER ALL TYPES ` WATER PIPING - , t 1 r OTHER t 1 I 'I _I i 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 0 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 of0' nowledge and that all plumbing work and installations performed under the permit Issued for this application will be in corn be in com ' wit e '' ent fon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� s PLUMBER'S NAME RICHARD OLSEN LICENSE# M10335 SIGNATURE MP ID JP CORPORATION 0# 2166 PARTNERSHIP❑# LLC❑# A COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 HOKUM ROCK ROAD CITY DENNIS I STATE I MA ZIP 02638 TEL 508-385-5290 FAX 508-385-6963 CELL EMAIL