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HomeMy WebLinkAboutBLDP-21-001363 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK F_• yz CITY YARMOUTH MA DATE 9/16/20 PERMIT# BLDP-21-001363 JOBSITE ADDRESS 21 BERWICK RD OWNERS NAME SAINT LOUIS ANDRE A CO TRS P OWNER ADDRESS SAINT LOUIS LISE CO TRS 18 DURHAM RD LONGMEADOW,MA 01106 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES ._j FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 0 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 Troy Gilbert LICENSE 16573 SIGNATURE MP © JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa@coastalphc.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK irw,_ I _fi,_ -' CITY West Yarmouth__ _ MA DATE 09/14/2020 PERMIT# BLDP-2I-obiNo3 • JOBSITE ADDRESS 21 Berwick Road OWNER'S NAME Lise Saint Louis POWNER ADDRESS 18 Durham Road-Longmeadow,MA 01106 TEL JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL LI RESIDENTIAL Li PRINT CLEARLY NEW:El RENOVATION:LI REPLACEMENT:Li PLANS SUBMITTED: YES[] NOO FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM d DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM Milli. 11 DEDICATED WATER RECYCLE SYSTEM 1 , I R. RR • on int am mounisimmormiormor mit DISHWASHER u DRINKING FOUNTAIN Il I FOOD DISPOSER 1 ! I FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) LAVATORY • -- •• •••••...,I. ROOF DRAIN II SERVICE/ m _ : --,-- iURINALii ,TOILET _ s• WASHING MACHINE CONNECTIONu WATER HEATER ALL TYPES 1 - 1 IFIIwiIll OTHER I l INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ej NO 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 Li 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 LI 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. 7-.8 I -t.- PLUMBER'S NAME Emily Gilbert LICENSE# 13573 OIGNATURE MP El JP® CORPORATION®# PARTNERSHIPLI# LLCLI# 4350_ COMPANY NAME Coastal Mechanical _I ADDRESS 21 L Fruean Ave CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX CELL 508-850-6955 EMAIL lisa@coastalphc.com