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HomeMy WebLinkAboutBLDP-23-003905 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11/4 u CITY YARMOUTH.-__--, ,,„ MA DATE 1/18/23 PERMIT# BLDP-23-003905 JOBSITE ADDRESS 1029 ROUTE 28 OWNER'S NAME YARMOUTH BAY ASSOC LTD INC P OWNER ADDRESS C/O SOVEREIGN BANK/TRAMMELL CROW CO PO BOX 14115 READING,PA TEL 19612-4115 TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO 0 FIXTURES 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:cap off drain and water lines 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 0 OTHER TYPE OF INDEMNITY❑ BOND El 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 Mark Febbi LICENSE p1238 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK A FEBBI ADDRESS 15 EDMANDS ST CITY SOMERVILLE STATE MA ZIP 021453044 TEL FAX CELL EMAIL ezduzit.maf@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ._f;rt- S 0 tr )e-i-Lh"/-'l MA DATE / C 7 -2-3 PERMIT# J'''~1 7 202BSITE ADDRESS/DZ f J*-Z.g' OWNER'S NAME //itllr744/71 4Si'C. ADDRESS �o dtIei e,l�-n s II_taIl uEPAP r S /S INce-C TEL 217G6 rZ4./d FAX BY TPt UK O,NCYTYPE COMMERCIAL)2 EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-f 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 I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL " SERVICE/MOP SINK TOILET URINAL . j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER CA y Orr i.r4/4'-f t/erl "?ci G/14- -C 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 0 BOND 0 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 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 compliance wi all Perti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# Z 11138. SIGNATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME C Z 171r2- / i /9 f(- ADDRESSSSm/S_17 ' 7m /.5 xx CITY 9//19-e�'1 kV;fie STATE ZIP v2 > TEL 4 22a/7d' I FAX CELL EMAILt7/,G'2/Tr/7 ® (J-