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HomeMy WebLinkAboutBLDP-23-006046 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK cv CITY YARMOUTH MA DATE 5/3/23 PERMIT# BLDP-23-006046 JOBSITE ADDRESS 69 ROUTE 28 OWNERS NAME PARI DEVANG CORP P OWNER ADDRESS 69 ROUTE 28 WEST YARMOUTH 02673-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES© 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/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© 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. PLUMBERS NAME Ronald Conte LICENSE 1)5696 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RONALD M CONTE ADDRESS 283 Cranview Rd CITY Brewster STATE MA ZIP 026312241 TEL FAX CELL EMAIL rcontemechanical@gmail.com • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =)_ CITY 1 CA.f WI "� MA DATE 5 A /Z PEAMIT�# ~ �roD�ffp JOBSITE ADDRESS 6 a 6 M -^Z' OWNER'S NAME POWNER ADDRESS b 6 AA. -Z g TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL d EDUCATIONAL El RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:Ei REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-+ KM 1 2 3 4 5 6 7 B' 9 10 11 12 13 14 BATHTUB 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 ROOF DRAIN SHOWER STALL - - SERVICE/MOP SINK TOILET RECEIVD ' URINAL . WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES MAY 01 2023 WATER PIPING OTHER pW V p_pq,r I E371LUINGt3EPARTMEN1 c0 „ylINI0 CA re- _ — INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El/NO IF YOU CHECKED YES,PLEASE INDICATE TH TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY 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 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. 2 .� CHECK ONE ONLY: OWNER 0 AGENT ❑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 i '0''`i C—°&)16 LICENSE# 1.5696 • SIGNATURE MP[3 JP a CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME )e-M, Coi T t' M E C Hsu ]C41 ADDRESS Z8"3 C eaVi V ie (4, IQ 0t CITY 13 v"Pyl1 s�e(Z STATE 144- ZIP 0 z 63/ TEL FAX CELL5og-Z37 -S7/7 EMAIL ?Coy MecllctYtiPdtI@ 14e01,17, covvv