Loading...
HomeMy WebLinkAboutBLDP-23-004692 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 CITY YARMOUTH MA DATE 2/23/23 PERMIT# BLDP-23-004692 JOBSITE ADDRESS 302 ROUTE 6A OWNERS NAME Mike Dyer P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL D PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES -1 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 0 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 3/1804 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 �.', I#Y 1►._. �i, ` ��'L:I � MA DATE VAIt AMI PERMIT# 2_3 — Li 40 9Z ;EB .' i A R SS 'e_27, ;?auk OWNER' NAME /tA 3 2,. Bu DING OWNER R' SS� t�'J�1 TEL. TEL FAX Sy �'ARTMENT ' .`�..... Y 'E COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL If PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:pn PLANS SUBMITTED: YESX NO El FIXTURES 1 FLOOR—► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I I 11 1.. l _ •: 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM l -. * I DEDICATED GAS/OIUSAND SYSTEM 1 I l DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 1 _r.._ I____ _ J( l. , DEDICATED WATER RECYCLE SYSTEM l a 1 DISHWASHER I._.._ DRINKING FOUNTAIN FOOD DISPOSER I I __ a.�_. I I _ FLOOR/AREA DRAIN I , : INTERCEPTOR(INTERIOR) I _ ,I KITCHEN SINK .1 kl_ ,� LAVATORY f 1 I _ I ' I r �_ ROOF DRAIN SHOWER STALL l 1 1I �, .g_.. SERVICE/MOP SINK TOILET I K, URINAL I '. I 14 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ;,re WATER PIPING l 11 l .,I _ l OTHER I 1 l I I I l_, L • _ r - I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 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 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 El 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 complian itfr all Perti roviis4on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I)1n WI 6-40 `�. PLUMBER'S N Of" /L n.G � LICENSE##/.Er0 „ "J Jam! SIG RE MP❑ JP II, i CORPORATION❑# PARTNERSHIP❑# LLC Olt COMPANY NAML nII4/l bird,p ADDRESS ::;///1---CITY eino STAT MI ZIP et?263 TEL .`58_-3101 —13 89. FAX CELL EMAIL