Loading...
HomeMy WebLinkAboutBLDP-23-006002 f .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTHilz k, MA DATE 5/1/23 PERMIT# BLDP-23-006002 JOBSITE ADDRESS 8 ARLINGTON ST OWNER'S NAME KURKER WAYNE TR P OWNER ADDRESS THE EIGHT ARLINGTON ST RLTY TRUST 1 WILLOW ST HYANNIS,MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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 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 El NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 IPaul Kelly LICENSE 1#1689 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PAUL J KELLY ADDRESS 70 SHOREWOOD DR CITY MASHPEE STATE MA ZIP 026492817 TEL FAX CELL EMAIL paul@keltyph.com I A ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _" CITY i�.c,2 t, 4 MA DATE Lf 2 4-- Z PERMIT# Z3 ' (90u Z 1-— 5 JOBSITE ADDRESS /7 Ay/ p•t_ ti s•1 OWNER'S NAME POWNER ADDRESS l'i �G7 n N r 5 !q ( t N G TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL©•------- EDUCATIONAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO 0 FIXTURES 7 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/01USAND 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 '— { ROOF DRAIN SHOWER STALL SERVICE I MOP SINK ►�- 1 TOILET URINAL s APR 2 71023 WASHING MACHINE CONNECTION 4 WATER HEATER ALL TYPES I WATER PIPING Eiu 1-77blii,_ rT1_ 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 POLICY OTHER TYPE OF INDEMNITY El BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT L',.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 9cmpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. )_ /` - PLUMBER'S NAME LICENSE# (16y . / SIGNATURE MP Er JP 0 CORPORATION 0# PARTNERSHIP � ❑.# LL 0# COMPANY NAME 'f`�\ T r 1-4 ADDRESS c 5hD c tcod�1 0 !/ �/� 1, -/J/� 2 CITY / fr91 STATE A ZIP v 26 ,c/�l � lTEL `�g SJ 7 Z FAX CELL �$ -a- EMAIL al I {'j , G o Ly • GV,- o b 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 •