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HomeMy WebLinkAboutBLDP-23-005539 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/5/23 PERMIT# BLDP-23-005539 rep I o JOBSITE ADDRESS 518 ROUTE 28 OWNERS NAME SANDBAR HOLDINGS LLC P OWNER ADDRESS 518 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO m FIXTURFS 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING 1 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 Jonathan Gremila LICENSE 1i6066 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# ( I COMPANY NAME JONATHAN GREMILA ADDRESS 38 McGuerty Rd CITY (Harwich STATE (MA ZIP 1026451506 TEL FAX CELL I EMAIL I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ; I�e, CITY Yarmouth 1 MA DATE 04-04-2023 PERMIT# JOBSITE ADDRESS 1518 Main St ice cream building I OWNER'S NAME Sandbar LLC • POWNER ADDRESS .__... TEL FAX, TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:Li REPLACEMENT:El PLANS SUBMITTED: YES E3 NO FIXTURES 1 FLOOR-+ BSM 1 2 3 4 J 5 6 7 8 9 10 11 12 13 14 BATHTUB ,... . . CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM alliii DEDICATED GAS/OIL/SAND SYSTEM 11111111111111 DEDICATED GREASE SYSTEM I l_ i nun DEDICATED GRAY WATER SYSTEM _ ' DEDICATED WATER RECYCLE SYSTEM f DISHWASHER 1 DRINKING FOUNTAIN ;i 3, FOOD DISPOSER I f- a FLOOR/AREA DRAIN ._ INTERCEPTOR(INTERIOR) fr e , _ ;� KITCHEN SINK I i_ LAVATORY ROOF DRAIN m I SHOWER STALL tg ; 9 it N. 1 v. t i '1 _.r6; �i� cP r - r- SERVICE/MOP SINK TOILET MIMI IIIIII 1111111111 111111 111.011111111 URINAL WASHING MACHINE CONNECTION .. 1 __._ __.. ... d,_ ... ` . a s . _ WATER HEATER ALL TYPES I 1 WATER PIPING ! 1 i OTHER I if 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 ID OTHER TYPE OF INDEMNITY 0 BOND Ej 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 CHECK ONE ONLY: OWNER Ej AGENT 0 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 Perti :' prov' '•• .-. - Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Jonathan Gremila LICENSE# 16066 SIGNATURE MPO JP 1p CORPORATION D# PARTNERSHIP/ • LLC Ei# COMPANY NAME JBG Plumbing&Heating INC ADDRESS 118 Daluze Dr CITY Harwich I STATE MA ZIP 02645 ( TEL 1774-722-3928 FAX 1- CELL EMAIL Zjgremila@yahoo.com