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Home My WebLink AboutBLDP-21-001744 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/5/20 PERMIT# BLDP-21-001744 wk JOBSITE ADDRESS 8 CIRCUIT RD EAST OWNERS NAME MAHONEY KEVIN M P OWNER ADDRESS MAHONEY INGRID S 38 SHERIDAN AVE MEDFORD,MA 02155 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES ..l 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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 Troy Gilbert LICENSE 1Y3573 SIGNATURE MP El JP ❑ 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 D FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK a_� � CITY West Yarmouth MA DATE 09/23/2020 ' PERMIT# Ubi Z I--Cb(74(c JOBSITE ADDRESS 8 Circuit Road East OWNER'S NAME Charlene Murray POWNER ADDRESS Sane TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E:I EDUCATIONAL LI RESIDENTIAL ED PRINT CLEARLY NEW:LI RENOVATION:LI REPLACEMENT:LI PLANS SUBMITTED: YES LI N0[J FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 I 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM li ! _ Il I DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM mNINON IMO IIIIIMININIIIIINNIE MIN INIFIIIII III DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ml� O. s .. FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK IIIIIIRllIllIllIlIllrilliIll111111111lFulllFillIllIlIl ME LAVATORY =RR RI _ _ ROOF DRAIN SHOWER STALL IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINII SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _ _ WATER PIPING URRUURRTi _ __ MIII IiISPI- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L3 NO ID IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY®' OTHER TYPE OF INDEMNITY ED BOND L3 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. iffC.[9?/Lt_ PLUMBER'S NAME Troy Gilbert LICENSE# 13573 SIGNATURE MPLI JPEj CORPORATION Li# PARTNERSHIPLI# jLLCLit/ 4350 COMPANY NAME[astal Mechanical ADDRESS L21 L Fruean Ave , CITY South Yarmouth STATE MA I ZIP 02664 TEL 508 737.18747 FAX CELL 508-850-6955 EMAIL lisa coastaphc.com 1 , OCT I i; ;� I i