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Home My WebLink AboutBLDP-23-005788 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ez CITY YARMOUTH MA DATE 4/19/23 PERMIT# BLDP-23-005788 JOBSITE ADDRESS 248 CAMP ST UNIT M4 OWNERS NAME COLLINS JOHN R P OWNER ADDRESS [1 DEERGRASS RD SHREWSBURY,MA 01545 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 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/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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 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❑ 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 Gary Jones LICENSE 8890 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME GARY C JONES ADDRESS 12 YEOMAN DR CITY W YARMOUTH STATE MA ZIP 026731432 TEL FAX CELL EMAIL 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 . \ 1 r R- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11';• CITY J? VC1.rM MA DATE 4 I7"013 PERMIT# 7—-/ — 5 76.9 JOBSITE ADDRESS a ti B . (0.e c...5 t On l- M-q OWNER'S NAME 1� G.4 k t f P OWNER ADDRESS d(-1 CUv)71 6J- Uh t f Yh'e( TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL KI— PRINT CLEARLY NEW:0 RENOVATION:[REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 FIXTURES 1 FLOOR-0 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 SYSTEM DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN _ INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY I ROOF DRAIN _ SHOWER STALL I _ SERVICE/MOP SINK TOILET r I URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER 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 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 application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT Er 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 rate 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 ' n all P 'nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBE 'S NAME •‘i '`)/Q 4 2&J LICENSE# ,0 9r() SIGNATURE MP JP 0 CORPORATION 0# PARTNERSHIP 0# LLC COMPANY NAME 6 a 1 j (',JC7Y 5 e 4'44 ADDRESS la *email ar- my t 1 V e,.4 J Gt(M STATE WW ZIP CJ0)-C 75 TEL.�C)% —SO J'o2 7 5 FAX CELL "SC9 d2 7.2S EMAILy -t0(Ia3 &t CO✓I/eOt6 , fle: