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Home My WebLink AboutBLDP-23-000679 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY IYARMOUTH MA DATE 18/9/22 PERMIT# BLDP-23-000679 r' I' JOBSITE ADDRESS 14 NICKERSON FARM WAY OWNER'S NAME Adam Riker D OWNER ADDRESS 14 NICKERSON FARM WAY SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ 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/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 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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 (Francois Paravisini I LICENS415211 I SIGNATURE MP © JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I I COMPANY NAME IFRANCOIS PARAVISINI I ADDRESS IPO Box 2585 I CITY 'Orleans I STATE IMA 1 ZIP 1026536585 I TEL I FAX I I CELL I 1 EMAIL (bayside@thecapecodplumbers.com -.. _.-. NIAOBACHUW11 INFO.*APINJCAIION FUR A IMUUNT w PINIMIUMI rompa~rift ,. cmroveg yp,(z-Nt OtA114 MA Dan, Q ILI JOBBITEMNIO . LI NICKOZSON FA12-0 WA/ OWNER'S NAME......ELLEL-----... ERADOPEO8 "Pa 221-13.i21.121.ria................, 'pm OR OOOMFOrlYPE 0010MCbt CI EDUCATIOWL C3 - RECNNIT1X.ali PRINT • INIANLY NEW.CI INDIOVATIOIt CI REF.IX MIS SUBMITTED: YES113 NOD FIXIMIrt ROC** IS112114 84 7 4 11411114114 , Jill., 1 f i i i 1 „I___L_ L.....--f..-7.,_7.,.41.7471,i. i!:*: II 11111 -,y...1 [ *1004 r gi f,„ y °=1 1'.117-'• r ilNik9.111' a la 17 7 g-.:-g 4,_At-r,ity I ...--, i• 41 . --.1T u.L-7.-T.,.:,-L.,-Ei... • -:.--74 1-,L--;4---i.-jiimIIIIIMIII 111=111111111 111111 ;17,i.:4:::•::::14,,L:,1'. imillill immil *tow i! :vv. - ii -- ' .. I MOP ega I 1 . I I i ! 1 . v.. 3 , 1 -,---yr 11111Mirri. , .V/_-• ' • 1111111111 II IIIIIIIIIIIIIIIIIIIININIIIIIIIIIIIIIIIMIIIIIIIIIIRIIIIHIIIMIIIIIIIIOIIIIMIIIIIIIIIMIIIIIIIIIN _ .1 1 I ill 111111111111111111111 NMI Ilan a must kiliklatmass polars loalbiodlolapitsidistib molitherispramands*SR OIL$12. YID NO CI FU CHICIROYES,RIME unexille IYPI OF CONWfliff OITOOR THE~wit NU BELOW UMW NOURANOOPRZY i ) 01RIRTYPE CI NIDINAtuiTY t3 use 12 GUINIMIINSUUNKIIMOISt 1 am molhetheissurropme=e- - amosa. . arsousi. niterrad by Cro in d ft llookuses Omni Las,ad the IN*pews We amados rapimmet DIMON'OILY: OWN CI MOW CI ---- - - ----- -. - ,1,._,.11,„.. c: tadix' '2. a ..-,1IhS =17' si giaiibbyi-- mit. 'anitionon f=id—midwife pendi Issued*. ippliodonviN be*...,..., . soh iftuadvasikolN*Pkimbing Cada evd 142dita fisraini tam , ucksaacrat_ . , 'T;.-11 "-7- iiinprirt•yii.... PLUMBe8 won — NPC1 PO CarCRATION CO C....205ffivia. iverNINHIPCIIL............................... la CI IL...................— °WAXY NAME—iiNOMaillMting114 -ACORE882SLBOLOS--.............................................. OITY....22MAIL.................................. STATE AL '..w.12201-- ---. ra.SAklaaiS------ eff...........----77441111-424 cat 774-21,6448_4_--. WEAL JEfigi IPCM222° 6Ma - -— .. .