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HomeMy WebLinkAboutBldp-22-001464 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/14/21 PERMIT# BLDP-22-001464 i ff JOBSITE ADDRESS 42 NAUHAUGHT RD OWNER'S NAME Lucy Bass P OWNER ADDRESS MA 02632 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOORS-- F{SM 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/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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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❑ 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. PLUMBER'S NAME John Giangregorio LICENSE W197 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 55 morning glory CITY Dennis STATE MA ZIP 02638 TEL FAX CELL EMAIL NONE ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I v I Y(,(/'l'YJal/`eL MA DATE �/ �/ Z l PERMIT* JOBSITE ADDRESS 192 AVa UJ,IGv/C�kf OWNER'S NAME LQC1 Bags POWNER ADDRESS L/2 iti4 u ha'ghf Rains Y4/V1od'r1n 1 Mf TEL 693-63 i—I'3 i FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 27 PRINT / CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Lid PLANS SUBMITTED: YES❑ NO FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 J B' 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM ______-- DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN �--� INTERCEPTOR(INTERIOR) — — KITCHEN SINK LAVATORY 1 ' —. ROOF DRAIN E C E I Vf U SHOWER STALL SERVICE I MOP SINK I TOILET 2Q URINAL 1 WASHING MACHINE CONNECTION i ,� Ill ig -! tsi ,E� WATER HEATER ALL TYPES Y - -- 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 0 NO !l IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY 0 OTHER TYPE OF INDEMNITY ❑ BOND ❑ i OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement r %.� CHECK ONE ONLY: OWNER [AGENT 0 SIGNATURE OF OWNER OR AGENT Lk.1 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 provis)on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -I© �1 )t 1 '/AAA I'(COP, LICENSE# ��� ���/'� N�RE MP 0 JP Le CORPORATION❑# PARTNERSHIP❑.# LLC p# / Tic/I COMPANY NAME ADDRESS cS ,704/4.25'ay 04/ CITY 22.e,19t'/'S STATE Mt9S. ZIP 60?6-3 TELos-.3Fs /.3 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES