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Home My WebLink AboutBLDP-21-004814 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e. CITY YARMOUTH MA DATE 2/25/21kr PERMIT# BLDP-21-004814 JOBSITE ADDRESS 108 BERRY AVE OWNERS NAME mary miller c-_ P OWNER ADDRESS 108 BERRY AVE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING OTHER 1 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. PLUMBER'S NAME Troy Gilbert LICENSE 15573 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC 0# 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 r.irrl>h-�,f, : 6LDP- ZI -06yVl lq=�.. CITY West Yarmouth _ _ MA DATE �02/23/2021 PERMIT# il JOBSITE ADDRESS 108 Berry Ave OWNER'S NAME Mary Ann Miller P OWNER ADDRESS 23 Otis Lane-Bay Shore,NY 11706 TEL FAX 4 TYPE OR OCCUPANCY TYPE COMMERCIAL[0 EDUCATIONAL ® RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES® NO0 FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM __.. DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEMimi DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM i V�I DISHWASHER ' =1 DRINKING FOUNTAIN I FOOD DISPOSER :l _l Y \_._ __lIlT'l1. ._ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK r LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL. WASHING MACHINE CONNECTION WATER HEATER ALL TYPES Mir 111111 Mill MI 1111111' WATER PIPING 111111� OTHER Steam Unit for Shower �II 0=1111111Fini11111`immillIPIIIII well ing11111100,11111 = 11111111111111111111111•111111111111111111111111111111111Img Igggi gigs mil 0.1',gm No ow imm in IneHmE 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 Q OTHER TYPE OF INDEMNITY ® 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 Ea AGENT 0 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. 226‘ NAME Troy Gilbert LICENSE# 13573 ydx&Lt- PLUMBER'S SIGNATURE MPU JPQ CORPORATION0# `PARTNERSHIP # LC Litt 4350 COMPANY NAME Coastal Mechanical ADDRESS�21 L Fruean Ave CITY South Yarmouth . STATE MA ZIP 02664 i TEL L508-737-8747 FAX CELL 508-850-6955 EMAIL lisa@coastalphc.com