HomeMy WebLinkAboutP-19-7295 w Y Rd
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
;� CITY Yarmouth MA DATE 06/28/19 PERMIT#/h'/ IF`�P'lo 4l.
JOBSITE ADDRESS 11 Reid Ave. OWNER'S NAME Raquel Miranda
OWNER ADDRESS 11 Reid Ave.
TEL �_o.. FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL El
PRINT
CLEARLY NEW: RENOVATION:El REPLACEMENT:Li PLANS SUBMITTED: YES 0 NO0
BATHTUB 1 2 3 4 5 FIXTURES 7 FLOOR 6 7 8 9 10 11 12 13 14
BSM
CROSS CONNECTION DEVICE I ____i._ :!_.._._ _ ____ I .
DEDICATED SPECIAL WASTE SYSTEM moniimanui Rigoinn
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM 1111111111.111111111111111111111111.11111.11111111111111riapiwim., nig
DEDICATED WATER RECYCLE SYSTEM .11 j '1 Th11-11.11
al'IN
FLOOR/AREA DRAIN 11111!R
INTERCEPTOR(INTERIOR) 111111jll ; =Mini
KITCHEN SINK
SHOWERROOF DRAIN
TOILET _ anon
URINAL
VVASHING MACHINE CONNECTION 11111PiiiiirMliMOINIIrtilifieligniniffilliiiliMiff,
WATER HEATER ' - =IOM MB MN NM WM MI MIN IMMI WWI WPM MI MI
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO ID
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY ID BOND El
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 El AGENT El
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 arc urate-tothe nest of m ••e
and that all plumbing work and installations performed under the permit issued for this application will be in co�pliarfce with all Pertinent provision of th=
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
'".-
PLUMBER'S NAME VIrgilio Silva LICENSE# 31395-J SIGNATURE
MP JP CORPORATION®# PARTNERSHIP0# 'LLC®#
COMPANY NAME Silva Plumbing&Heating ADDRESS 155 Sudbury Lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX 1 CELL 774-836-0176 EMAIL virgiliomga@hotmail.com
fi/s/
afi
l ' r
i
'f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
=tip I. CITY Yarmouth MA DATE 06/28/19 PERMIT#/ 12P/f—r.V 7a95"
JOBSITE ADDRESS 11 Reid Ave. OWNER'S NAME Raquel Miranda
GOWNER ADDRESS 11 Reid Ave. TEIJ FAX _
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES Ej NO 0
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 1 7 8 9 i 10 11 12 13_ i 14
BOILER
BOOSTER
CONVERSION BURNER '1 -
= -DIRECT VENT HEATER Inns __, �.. a
COOK STOVE : , il
DRYER , if . NE
rip
IRII1I !PmE
FIREPLACE -
• • , II!-.�
5
gigs' , _ ILUI [}[ . .
GRILLE El ii, ‘, , .. ., I
,un
INFRARED HEATER
LABORATORY 11111•
I+AAKEUP AIR UNIT .11.111.1
OVEN
f:
POOL HEATER
ROOM/SPACE HEATER i
ROOF TOP UNIT ,' if
UNIT HEATER _ _
WATER HEATER TEST
• w ='III
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY LI OTHER TYPE INDEMNITY 0 BOND Q
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 U AGENT Ei
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 a. •- - : - -:. - • knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in corn•' .-with all Pertinent provision • the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws-
r7
PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J GN FURE
MP 0 MGF 0 JP JGF ri LPGI 0 CORPORATION®# J PARTNERSHIP Elk,...w.n .-..__x1 LLC 0# J
COMPANY NAME:Silva Plumbing&Heating ADDRESS 155 Sudbury lane
CITY Hyannis STATE MA ZIP 02601 TEL L
FAX L I CELL 774-836-0176 EMAIL virgiliomga@hotmail.com
N"'""fln
\ I
n
N