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HomeMy WebLinkAboutBLDP-23-005443 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w ; u CITY YARMOUTH MA DATE 3/31/23 PERMIT# BLDP-23-005443 7 on l ?� JOBSITE ADDRESS 891 ROUTE 28 OWNER'S NAME SWAMINARAYAN LLC P OWNER ADDRESS MAHENDRA R BHATT 891 ROUTE 28 SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO m FIXTURFS 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/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. PLUMBER'S NAME Donald Raymond LICENSE Z5836 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DONALD L RAYMOND ADDRESS PO BOX 522 CITY YARMOUTH PORT STATE MA ZIP 026750522 TEL FAX CELL EMAIL expertenergyhvac@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r= ' CITY LA- MA DATE ‘83 41RmLiip--. JOBSITE ADDRESS ` DB OWNER'S NAME OWNER ADDRESS ` calk—V %C.- TEI)-6 ((40I?)AX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL*/ PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:[r PLANS SUBMITTED: YES 0 NO f4 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DOAK INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN 1r'•' mr SHOWER STALL SERVICE/MOP SINK TOILET A! : 123 URINAL WASHING MACHINE CONNECTION THE I T WATER HEATER ALL TYPES WATER PIPING OTHERkelk \) V VNC5 &&k . AeI; Q D\ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE NO ❑ IF YOU CHECKED YES,PLEASE INDICATE E TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY Cj 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. CHECK 01 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 a- - « best my knowledge and that all plumbing work and installations performed under the permit issued for this application will be . **1 a P -, p of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# D IG ►TURF MP❑ JP CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME (V ADDRESS "Z k-C ` .A hi CITY qii,c- as,,, ,i,_\kvttsit STATE ZIP TFZIN V13)-1b te- FAX CELL EMAIL( f t ,-nil