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HomeMy WebLinkAboutBLDP-23-003481 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r/ CITY YARMOUTH MA DATE 12/23/22 PERMIT# BLDP-23-003481 fG JOBSITE ADDRESS 481 BUCK ISLAND RD UNIT 7D OWNER'S NAME Susan eaton P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL al PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 1 FLOORS-4 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 LAVATORY 1 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 Jay Oster LICENSE#1319 SIGNATURE • MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JAY B OSTER ADDRESS 140 Kennedy Dr Apt 4 CITY Malden STATE MA ZIP 021483400 TEL FAX CELL EMAIL jay.oster65@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 CITY/TOWN\Iu;A mNIVN 2-(01 MA DATE 1L 111 122 PERMIT# 2 3- 3'f / JOBSITE ADDRESS I 611t- I SI .at 14d #70 OWNER'S NAME Su SCt f Eaton OWNER ADDRESS Li is 1 S t ft'/ f(a it 1 D TEL 171-1 tin 1 7 2- FAX —_ __.......__ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL, ] PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: 9i PLANS SUBMITTED: YESSj NO❑ FIXTURES 7 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 DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY t ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES_WATER PIPING ��ww OTHER 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. CHECK ONE ONLY: OWNER GENTA) 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 e best y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a inent Massachusetts State Plumb Code and Chapter 142 of the General Laws. PLUMBER'S NAME I 0,A1b Skil LICENSE# 11 ,311 GNA MP I2( JP❑ CORPORATION['# `I 3 ( PARTNERSHIP❑# LLC❑#69to 4 LLC ADDRESS 55 b C bq°DCf 1-t (7Ik Q r , Pemb,�Y Q Mo� -3 COMPANY NAME ti� ¢ �/ CITY gin ko r� STATE mft ZIP a a 35 9' TEL I 0 (— ga 6--{ i q FAX - Lit Li CELL f)I t'/i� I s"C 15'( EMAIL Ttill. OSie 6q (7nI1G1 t. coM