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HomeMy WebLinkAboutBLDP-19-001240 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -44•71-- CITY YARMOUTH MA DATE 8/29/18 PERMIT# BLDP-19-001240 JOBSITE ADDRESS 93 STRATFORD LN OWNER'S NAME DAVENPORT P OWNER ADDRESS 20 NORTH MAIN STREET SOUTH YARMOUTH, MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: 9 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES 1 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 3 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 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 m NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 9 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 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 Jeffery Ricardo LICENSE#3256 SIGNATURE MP © JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC 04 COMPANY NAME Jeffery A Ricardo ADDRESS 9 S MAIN ST • CITY CARVER STATE MA ZIP 023301500 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ erourr FEES$ PERMIT* PLAN REVIEW NOTES MASSACHUSETTS • UUNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK CITY Ir.�S/t'frs•r.S?1 e' -c6- . � MA DATE $ IT PERMIT# L l9-ab/2.yv JOBSITE ADDRESS ( 3 SCS k' OWNER'S NAME 1/04-ci, OWNER ADDRESS A) • ,J 4 rl"' TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14~ BATHTUB I - CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM - DISHWASHER I ' El V E D I DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN A(7 „ 2ifid 2I INTERCEPTOR(INTERIOR) [ KITCHEN SINK / BJILDING ?EPA RTME LT LAVATORY 3 °Y' ROOF DRAIN SHOWER STALL /• • ! SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION / WATER HEATER ALL TYPES / WATER PIPING / OTHER / J /(o INSURANCE COVERAGE: � I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ❑ IF YOU CHECKED YES,PLEASE INDICATE�THHEETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILFTYINSURANCE POUCY !Z 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 ap9lication waives this requirement r CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT Ll I hereby certify that all of the details and informal on 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 pr. 'sion of the Massachusetts State Plumbing^de and Chapter 142 of the General Laws. /// • PLUMBERS NAME S � C �,�LICENSE# /3x56 7 SI V RE MP 9----JP 0 CORPORATION 3/6 tI PARTNERSHIP O# Q LLC # 904614- COMPANY NAME 6264 t C , ADDRESS3-3 T 1 Fcjccc tQ GC Al CITY PAf.446-tiCM STATE Ala ZIP C36o TEL 72 773 94'593 FAx CELLCI rV6 ( EMAIL )Ct9L'n&ri i\f‘G e_ 1/a 1 VD /A- �T frftfr .40 2rictd ),(9' 7161 Pig