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HomeMy WebLinkAboutBldp-21-005005. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/5/21 LI PERMIT# BLDP-21-005005 f I JOBSITE ADDRESS 135 SOUTH SHORE DR UNIT 2 OWNER'S NAME SAFFORD HOWARD I P OWNER ADDRESS SAFFORD M J&ORENSTEIN H C&R L 92 JUNIPER RIDGE DR FEEDING HILLS, TEL MA 01030 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 2 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 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 0 OTHER TYPE OF INDEMNITY❑ 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 Joselin Sanchez LICENSE 3t1804 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSELIN C SANCHEZ ADDRESS 108 BAYVIEW ST CITY WEST YARMOUTH STATE MA ZIP 026738211 TEL FAX CELL EMAIL giovannisanchez524@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No / ci lc /qv y C�~ THIS APPLICATION SERVE AS THE PERMIT ❑ (2 JL- FEES$ PERMIT# PLAN REVIEW NOTES ivi 4 P : pARc_ci--: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _,`-J1°! CITY dig w)04 MA DATE ,�J PERMIT# aL D P- Z l- bU �oG .KX3SI E ADDRESS/. s aV - 1 `' 4 OWNER'S NAME( ')0Y1 4 tail' I% `` ti j OWNER ADDRESS ��rtr•i/ 4"--) 7 hirer TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Dif PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:T PLANS SUBMITTED: YES ' NO❑ FIXTURES 1 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Z CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 Z, ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET Z URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 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 r 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 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. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the detals 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 ' II Peril t pro n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c�( es...) Y1 - �V_ PLUMBER'S NAM JvSt I,�A C•$i 4)tL LICENSE#3/ 6 v( SIGNATURE MP❑ JP CORPORATIONP ❑# PARTNERSHIP❑# LLC❑# COMPANY NAME( 6 Lier,n) 9/vw L,r ADDRESS j/t/CITY ,L' t / STATE4 ZIP _. TEL . -30 13Si FAX CELL ..0 -3 CFO-l3 t EMAIL f ICE►^1>,/l (0.( �} .')1411: Lbi`i