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HomeMy WebLinkAboutBLDP-23-005124 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/17/23 PERMIT# BLDP-23-005124 JOBSITE ADDRESS 864 8878 ROUTE 28 OWNERS NAME DIGIOVANNI GERARD J P OWNER ADDRESS DIGIOVANNI JOSEPH 67 BAKER ST BELMONT,MA 02178-4024 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO m FIXTURES .l 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES m NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 Gary Famigliette LICENSE 10191 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME GARY FAMIGLIETTE ADDRESS 67 MAPLE AVE CITY HYANNIS STATE MA ZIP 026014403 TEL FAX CELL EMAIL FAMCO@COMCAST.NET MAS ,CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK._ 1CC�(VI� ,-/ - � MA DATE c3 IS aZ3 PERMfT#L��-�3 I 'R 1 I ; A'DRESS g 6% i'C �.' S &n i�'"( � 6 I OWNER S NAME�2oC��i OWN AD D RESS I BU �Y7 LL G DEPAR{ME TEL FAX -y MT OR i'i= °.k I Y TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL] PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:RS' PLANS SUBMITTED: YES 0 NO EX 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ' DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER II DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) t KITCHEN SINK LAVATORY _ ROOF DRAIN " SHOWER STALL SERVICE/MOP SINK _ TOILET - URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _ INSURANCE COVERAGE: { I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES at 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 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 1 Massachusetts General Laws,and that my signature on this permit apQlication waives this requirement. • CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z. SIGNATURE OF OWNER OR AGENT L1.I I hereby certify that all of the details and information I have submitted or entered regarding this application 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 I plian 'th all Pertinent provision of the Massachusetts State Plumbing Code andte Chapter 142 of the General Laws. PLUMBER'S NAME G a`'� �Tu`�^ °�� LICENSE# 10/q I . SIGNATURE MP qa, JP❑ _ CORPORATION 0# PARTNERSHIP❑.# LLC 0# COMPANY NAME Yh 0 ADDRESS 6 7 "'I jlo ). v 'f. CITY / G 4(1;s STATE Gtitc ZIP 40/1 b d/ TEL sO g ' 77.5-.�-C°?.1- FAX CELL SW, .02 O —S`C-A- EMAIL su et-e o ` r)A Cc 5 a'. 65��