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HomeMy WebLinkAboutBLDP-23-006043 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/3/23 PERMIT# BLDP-23 006043 III JOBSITE ADDRESS 49 VACATION LN OWNER'S NAME CIULLA ANTHONY J p OWNER ADDRESS CIULLA MARGARET N 8 CAIN AVE BRAINTREE 021840000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL Ill PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES NO m FIXTURES z FLOORS-0 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 1 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© 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 El 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 Richard McGrath LICENSE 13282 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ARS BOSTON ADDRESS 300 Manley St. CITY West Bridgewater STATE MA ZIP 023790001 TEL 5085889025 FAX CELL EMAIL 8577permits@ars.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -- ,' CITY West Yarmouth IMA DATE 4/25/23 PER JOBSITE ADDRESS 49 Vacation Lane I OWNER'S NAME Tony Ciulla POWNER ADDRESS 49 Vacation Lane I TEL 781.664.7088 (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Ej EDUCATIONAL 0 RESIDENTIAL ID PRINT CLEARLY NEW:® RENOVATION:Li REPLACEMENT:LI PLANS SUBMITTED: YES li NO FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE �I m i 11 Ii I 1II 1 I _ DEDICATED SPECIAL WASTE SYSTEM � I - 1 - �I . _ 1 a � - I _ _I II. DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM N �J DEDICATED WATER RECYCLE SYSTEM II �I Y I` Y IHWASHER . _ �- M- 'it , .* .I.i .x t ,• I «/ l i.- DRINKING FOUNTAIN I FOOD DISPOSER III 1 FLOOR/AREA DRAIN J. y I INTERCEPTOR(INTERIOR) i � N KITCHEN SINK �� -, I - LAVATORY �I {I ROOF DRAIN I SHOWER STALL .I IL SERVICE/MOP SINK TOILET A._,..W„11 1 , URINAL IL11 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 _ t, _ I WATER PIPING }' OTHER Ill _ iil I _ 4 1 a_, i .� I F j II INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El 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. CHECK ONE ONLY: OWNER L AGENT Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t - - d accurat the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn - e wit, - r rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I Richard McGrath .,I LICENSE#113282 I lei/ SIGNATURE MPO JP 0 CORPORATION LI#I 4542-PLC PARTNERSHIP S]#I J LLC®#I I COMPANY NAME! ARS BOSTON I ADDRESS l 300 MANLEY STREET CITY[WEST BRIDGEWATER I STATE I MA I ZIP 102379 I TEL 1508-588-9025 FAX 508-583-7806 CELL 508-631-0515 EMAIL I8577Permits@ars.com I