HomeMy WebLinkAboutBLDP-23-0043974 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 2/8/23 PERMIT# BLDP-23-004394
l I JOBSITE ADDRESS 9 ACADIA RD OWNER'S NAME Albert Denapoli
n OWNER ADDRESS 9 ACADIA RD WEST YARMOUTH,MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW: m 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 1
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 El 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 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.
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 Andrew Hayes LICENSE 16489 SIGNATURE
MP 0 JP 0 CORPORATION ❑# PARTNERSHIP 0# LLC 0#
COMPANY NAME PLUMBING SOLUTION BY HAYES ADDRESS 22 Rustic Lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX CELL 7747225013 EMAIL PLUMB_HAYES91@YAHOO.COM
.
MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK
VrEY r as t. MA DATE a1 s 1 as3 PERMIT# ZZ — h
O P ,1O BITE AD)RESS Cf A c 0.c1 ;c. IZon d OWNER'S NAME 3 t c 1- 0241 ap oe,
2023
OWNER ADE RESS 9 1k mot ,c, TEL FAX
B1.1.11SING DEPARTMENT
sy!T rE OR— OCCUPANT"'TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0r's
PRINT
CLEARLY NEW:V RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO(]/
FIXTURES 1. FLOOR—► BSM 1 2 3 4 5 6 7 B' 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/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY •
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK •
TOILET
URINAL
WASHING MACHINE CONNECTION -
WATER HEATER ALL TYPES I
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 EI/NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Ly OTHER TYPE OF INDEMNITY 0 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 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
L:l 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 all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME li'hd.Uw Gtot LICENSE# . SIGNATURE
MP E JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC 0#
COMPANY NAME t'lurn6zOQ Sah 41e„S p4../ ADDRESS l? &Shc Loa--
CITY ��ul Rno�3 J STATE f" A ZIP 61.1.. 6 + TEL
FAX CELL 71-1- -sot 3 EMAIL pi ur+. _ tIctvel R I (Ljc:.tiro.r 6A,