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HomeMy WebLinkAboutBLDP-23-003131 .ti MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -,v CITY YARMOUTH MA DATE 12/7/22 PERMIT# BLDP-23-003131 iffy l' JOBSITE ADDRESS 5 DUNDEE DR OWNERS NAME Laurie Quinn P OWNER ADDRESS 5 dundee YARMOUTH PORT,MA 02675-1518 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL al PRINT CLEARLY NEW: m 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 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 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:bar sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 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 'Michael Mcbride LICENSE t9681 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS 9 Rustic Drive CITY West Yarmouth STATE MA ZIP 102673 ' TEL FAX I I CELL EMAIL stinger.mcbride@gmail.com r' ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __ . CITY e4/? tiMA _DATE // ) 7 2- PERMIT# Zt - $1 3 JOBSITE ADDRESS 5-D(/r)(Jse /2Oa O - OWNERS NAME / POWNER ADDRESS �}(�'EL / 4Z%Q'� FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCA ZONAL ❑ RESIDENTIALA PRINT CLEARLY NEW:[ya, RENOVATION:❑ REPLACEMENT:V PLANS SUBMITTED: YES®- NO❑ FIXTURES-1 FLOOR-4 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 -r- DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER / DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN _ INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY K �' V 13 ROOF DRAIN SHOWER STALL nor +.. ryn" SERVICE/MOP SINK - wzz TOILET ' URINAL ' BUILDING UthA-Z I ME v I WASHING MACHINE CONNECTION 13y` - WATER HEATER ALL TYPES WATER PIPING OTHER /qc- S/sit< / - _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESOE NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY IR- 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. T CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT L',I 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. c� �` ��— PLUMBERS NAME M i C./,Q pL !' (_A) ‘ LICENSE# II 1. SIGNATURE MP El JP Uil CORPORATION❑# PARTNERSHIP 0.# LLC❑# COMPANY NAM�I4 (.i I`t I P-H:! ADDRESS '7 1fQ4L -J,, I:-yam 14 l/ e CITY lisli) //5 STATE / - ZIP 6 Z lr�Q/ TEL 77 y g-/ ( eZ_ FAX CELL 77 7 V O !(2 Z EMAIL 5 /1 cj PJ'• M�J3 r t an ®c, A-A...r:uN, ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1