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HomeMy WebLinkAboutBLDP-23-005364 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK K_ , „6 CITY YARMOUTH MA DATE 3/30/23 PERMIT# BLDP-23-005364 JOBSITE ADDRESS 168 CAPT NICKERSON RD OWNERS NAME MICHAEL CURLEY P OWNER ADDRESS MEGHAN AND JAMES CASEY 24 HAMPTON CT WALPOLE 02032-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES El NO m 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 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 1 • SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 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❑ OWNERS 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 Nagle LICENSE 10756 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RICHARD F NAGLE ADDRESS 12 Funn Pond Rd CITY South Dennis STATE MA ZIP 026601906 TEL FAX CELL 5083140406 EMAIL rfnagle1960@gmail.com r 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 . OS) a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ='j1=9= CITY )1 (ii 'd YL MA DATE AIA- PA4IT"# - Z 3-co t,y a JOBSITE ADDRESS IG O ea P'i-a; ✓t 13 t f Se"D OWNER'S NAMES I'NQS Ca_5 2i.� P OWNER ADDRESS S m TEL FAX 13 TYPE OR OCCUPANCY TYPE COMMERC AL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ 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/OILISAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER / • , DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN _ INTERCEPTOR(INTERIOR) _ KITCHEN SINK it _ - LAVATORY • ROOF DRAIN 1--- SHOWER STALL i —4 E f l id , D- , SERVICE/MOP SINK • TOILET Att►0 s1Eri • t URINAL . WASHING MACHINE CONNECTION • _ _ D WATER HEATER ALL TYPES __ UILDINC B-EFARTMCII-T WATER PIPING ay.. _ ,--- OTHER _ l 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 E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT ❑ Z SIGNATURE OF OWNER OR AGENT I I hereby certify that all of the details and information I have submitted or entered regarding this application are accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will compli with all Pertinent p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c^ PLUMBER'S NAME LICENSE# /D'75-4. �`'` �SIGt4 RE MP JP❑ CORPORATION 0# PARTNERSHIP❑.# LLC 0# C MPANY NAME R • \ t3 51,-- Rjur j h►'nS ADDRESS I Z F.v A n PaICI P-s CITY)11n .r 4 STATE Mk ZIP 02/�. TEL 7v•-237 9209 rd`FAX CELL ' �-3j/Y.-6 fOL EMAIL p F z5l p I /4e e &P141/ ' eDA%1 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