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HomeMy WebLinkAboutBLDP-22-001074 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ey CITY YARMOUTH MA DATE 8/24/21 PERMIT# BLDP-22-001074 t' z JOBSITE ADDRESS 112 DRIFTWOOD LN OWNER'S NAME PENNY ROBERT H TR P OWNER ADDRESS DRIFTWOOD LANE RLTY TRUST 13 ORTON ST WORCESTER,MA 01604 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:El PLANS SUBMITTED: YES NO El FIXTURFS • 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 1 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 m OTHER TYPE OF INDEMNITY 0 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. 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 Michael Saurette LICENSE 314174 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME saurette brothers ADDRESS 7 Barnhouse Road CITY Dennisport STATE Ma. ZIP 02639 TEL FAX CELL EMAIL dwallace33@outlook.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPUCATION SERVE AS THE El FEES$ PERMIT# PLAN REVIEW NOTES