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HomeMy WebLinkAboutBLDP-21-007552 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ft CITY YARMOUTH MA DATE 6/28/21 PERMIT# BLDP-21-007552 JOBSITE ADDRESS 6 KATES PATH VILLAGE OWNER'S NAME MIRABILE JOSEPH P TRS OWNER ADDRESS MIRABILE ANITA L TRS 6 KATES PATH YARMOUTH PORT,MA 02675-1442 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑ FIXTURES 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/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 1 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE 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 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 Eric Bourett LICENSE 34661 SIGNATURE MP El JP © CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME ADDRESS 48 Summer St CITY Dennisport STATE MA ZIP 102639 TEL FAX CELL EMAIL EBOURETT@GMAIL.COM . ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT 0 ❑ FEES S PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e -; CITY L :�co�1-4_ G.. t /Y 4- MA DATE c•/), o2" / PERMIT#6LD P-.2 t.o 7 5 c1 JOBSITE ADDRESS 42 KS e.c 194-4Lfit" '--'L P'''ty OWNER'S NAME-J 'ni.4t')e- POWNER ADDRESS f fa",e cZ-r ez: c°Ue_ TEL FAX ` { /PE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL p----- PRINT CLEARLY NEW:❑ RENOVATION:GI REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO FIXTURES 1 FLOOR-+ 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/OIUSAND 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 I/ SERVICE/MOP SINK TOILET _ - URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / WATER PIPING ti/ _ OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POUCY 0 OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSU'=NCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachu - - eral Laws,and that msignature on this permit application waives this requirement. 49r CHECK ONE ONLY: OWNER / AGENT 0 SI NATURE 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• mvJSncededq and that all plumbing work and installations performed under the permit Issued for this application will be inciance ;i.r. ; n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# L 3 i,�.,66 I .. 5 SIGNATURE MP❑ JP `N ) A CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME �.� T l 1 J ADDRESS t-1 5-I 0\ S t CITY Uerltl�S�Iof� STATE J I4 ZIP 67.6 36( TELL 5) '2-1?-1570 70 FAX CELL EMAIL e b0 0 re O w1Gi.1 a Co idk