Loading...
HomeMy WebLinkAboutbldp-23-005910 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK : °�1 CITY YARMOUTH MA DATE 4/25/23 PERMIT# BLDP 23 005910 JOBSITE ADDRESS 38 BRUSH HILL RD OWNERS NAME GENEROSO PHILIPPE BP P OWNER ADDRESS 38 BRUSH HILL RD YARMOUTH PORT 026750000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES NO m FIXTURES 1 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Michael Saurette LICENSE 41174 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SAURETTE BROTHERS ADDRESS 7 Barnhouse Road 7 Barnhouse Road CITY Dennisport STATE- Ma. ZIP 02639 TEL FAX CELL EMAIL rsox555@gmail.com • 50 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1-1 _fi> CITY YCl(�f7'1UCJ�) Poi+ i �[ MA DATE Afri I A ). PERM #T" 23-id S74 JOBSITE ADDRESS 3 COY-V S) H 1 1( i d OWNER'S NAME _ t'I I�eC �-. sc eCc P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION;,�J` REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 FIXTURES 1 FLOOR—► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 BATHTUB 14 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL ` , i WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES WATER PIPING OTHER Ven 'y x INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YEtNO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY 0 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. 2 ' SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ElAGENT El LU 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 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. knowledge PLUMBER'S NAME 1�t Loge( sq U('e It LICENSE# 34--l 71 SIGNATURE MP❑ JP K. CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME D�n �Cf()�'P ( \ f C) ADDRESS 7 Cf k 0(/S CITY rs���,��- rd. STATE 6j ZIP 7 TEL FAX CELL Z7_g$7Or�0G(f EMAIL .caC 5 {l'1 q t 1. C'd