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HomeMy WebLinkAboutBLDP-23-004487 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK wa CITY YARMOUTH MA DATE 2/13/23 PERMIT# BLDP-23-004487 JOBSITE ADDRESS 47 CAMP ST OWNERS NAME BAKER JOHN M P OWNER ADDRESS BAKER ELIZABETH A 41 CAMP ST WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL Q PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES l 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/OIUSAND 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 1 ROOF DRAIN SHOWER STALL 1 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. PLUMBER'S NAME Kevin Spry LICENSEI3698 SIGNATURE MP ❑ JP ❑ CORPORATION ©# 3598 PARTNERSHIP ❑# [ LLC ❑# COMPANY NAME SPRY PLUMBING&HEATING LLC ADDRESS 54 HIGHLAND STREET CITY ROCKLAND STATE MA ZIP 027671503 TEL FAX CELL EMAIL i ' c) ��,�1�-3 es • O. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -`"-•' I vi ' /A11—M Ova MA DATE a 13 a 3 PERMIT# - -OA JOBS ADDRESS 'I&7 CA IP ST OWNER'S NAME -TO(,ty 6r41 1i: F 13 pO�nv L__ AJDRESS TEL S1)g (0.5-34 FAX BUILDING UI TYPE ['EPA Ruu& At,CY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 529 PRINT—j CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:' PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 B' 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM -~ DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 1 DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK _ LAVATORY / ROOF DRAIN SHOWER STALL / SERVICE I MOP SINK TOILET URINAL 1 . ( WASHING MACHINE CONNECTION • WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: j I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YEStg 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 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 ap?lication waives this requirement. • CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT L1.1 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 portySIlan th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME K- �V i ti► SPRY LICENSE# r9b . S ATURmE MP❑ JP❑ II CORPORATION❑# PARTNERSHIP❑.# LLC®# 3 5-1.$" COMPANY NAMELSP�� ��M h v t' h� uL ADDRESS 't ��'3Art L.1 4-Th 111' '( b CITY e_o aQ STATE VA a ZIP tad-3-1 E0 TEL -1 V I- `I $ FAX CELL- I-"10 4-0(40 EMAIL Con 4e,c.�►- �S_vc� v n�tri S • c o w ROUGH PLUMBING INSPECTION NOTES $FLOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • •