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HomeMy WebLinkAboutBLDP-23-000693 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �, CITY 'YARMOUTH MA DATE 8/10/22 PERMIT# BLDP-23-000693 JOBSITE ADDRESS 112 BURCH RD OWNER'S NAME TIGHE ROBERT J TR P OWNER ADDRESS 112 BURCH RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES CI NO❑ FIXTURES 1 FLOORS-4 BSM 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 4 ROOF DRAIN SHOWER STALL 1 3 SERVICE/MOP SINK TOILET 2 3 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING OTHER 2 OTHER DESCRIPTION:bar sink steam unit 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 (Brian Ricci LICENSI126181 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# COMPANY NAME IBRIAN RICCI ADDRESS 18 ROCKMEADOW DR CITY IE BRIDGEWTR I STATE IMA I ZIP 1023332433 I TEL I FAX I I CELL 1 EMAIL (ricciplumbing@yahoo.com CID- 4 O,Zn w,- Jmo fsd APPLICATION# ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ji C- a+=? 4—'tc of I MA DATE I 6 -id --� I PERMIT# 2-3O(0 S 3 / _11 �. JOBSITE AD R-SS ' OWN � AUG 'OWNERAD f 2 �kRf"N -/�D- OWNER'S NAME�LuTt'f aLci Gs�t! ��l Mau CK E II2- ?0 TEOcji 3oi. 7./to FAX _________- RWRZTeNtY_ 'E COMMERCIAL El EDUCATIONAL ID RESIDENTIAL CLEARLY NEW:Kj RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO IZI FIXTURES 1 FLOOR—. 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 SYSTEM DISHWASHER ' DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL 1 � ' SERVICE/MOP SINK ' TOILET 2 3 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING OTHER$,q({ SIN< TSLAi'IP STEAK UILlT I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 121 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY gi OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in pliance II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I&AN Rom, LICENSE# 6/r/ //SIGNATURE MP❑ JP lig CORPORATION❑# PARTNERSHIPS#I Pm LLC❑#I COMPANY NAME kid 4/ilk +11/kAT7ig- ADDRESS A R // */ CITY geKT r Wh STATE r/. ZIP 6,1. 33 TEL 7�i..,24 _5/7,2. FAX I I CELL gc6l 104AY I EMAIL I f I a., ph/AAA/A, a 6r) co., _ THIS APPLICATION SERVES AS THE PERMIT YES NO FEE:$