Loading...
HomeMy WebLinkAboutBLDP-23-004070 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/24/23 PERMIT# BLDP-23-004070 JOBSITE ADDRESS 248 CAMP ST UNIT F2 OWNERS NAME FERNANDES MARIA H P OWNER ADDRESS 20 CAPT NOYES RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS 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/OIL/SAND 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 1 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 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 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❑ 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 Joselin Sanchez LICENSE 3t1804 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY'NAME JOSELIN C SANCHEZ ADDRESS 108 BAYVIEW ST 108 BAYVIEW ST CITY WEST YARMOUTH STATE MA ZIP 026738211 TEL FAX CELL EMAIL plumbing657@gmail.com / D ' -- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � � .� �-® outh I MA DATE 11/18/23 PERMIT# I -7e: DI-ESq !/g n7pS-- on OWNER'S NAM a/Yf1 Fl,w7, 6.5 i N 1d R .DD•ESS " .� Q..44 L/ TEL FAX BrititbivE'oeC i TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL 0 ' T --- CLEARLY NEW: IN RENOVATION:❑ REPLACEMENT:C] PLANS SUBMITTED: YES Q NO[] FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( ' I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER ' 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK -. .._ _ . . _ � � _ ' 1_ � i TOILET URINAL :_ .... .r 11101111111111111111011111111111111111111111111111 'r ' WASHING MACHINE CONNECTION 11 ! 11 !: I,, WATER HEATER ALL TYPES I i a WATER PIPING s! ;a f OTHER i a , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial � equivalent which meets the requirements �uirements 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 s' 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 CHECK ONE ONLY: OWNER f I AGENT 1 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 can 1' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. p with all Perti nt provision of the PLUMBER'S NAME IJoselin Sanchez aTp Pe)'LICENSE#131804 \I GNATURE MP ' JP t..E CORPORATION ,# PARTNERSHIP #_ LLC, # COMPANY NAME Giovanni plumbing ADDRESS N/A CITY West Yarmouth STATE Ma ZIP 02673 TEL 508-3601389 FAX =CELL 508-3601389 EMAIL plumbing657@gmail.com p 9 @gmail.com