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Home My WebLink AboutBLDP-23-004261 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 5 - ez CITY YARMOUTH MA DATE 2/1/23 PERMIT# BLDP-23-004261 74 l 11 s JOBSITE ADDRESS 15 BARNACLE RD OWNER'S NAME Nick Papakyrikos P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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/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 0 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 Kevin Meehan LICENSE#1877 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KEVIN M MEEHAN ADDRESS PO BOX 35833 CITY BRIGHTON STATE MA ZIP 021350014 TEL FAX CELL EMAIL pjmc007@hotmail.com MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK 1 " EIS/ U ox MA DATE I -3 t - 2-3 PERMIT# Z-S' 49 Z G/ AN 492§1s A D SS /S 13o-r.1ac(.c a.SZ . OWNER'S NAME tJ cckc Pc..pc 6y il kcc 1 SS aU L[NNG LE� TEL FAX aY PE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 1-jj. PRINT CLEARLY NEW:El RENOVATION:0 REPLACEMENT:a-- PLANS SUBMITTED: YES 0 NO®- FIXTURES 1 FLOOR-4 13 BSM 1 2 3 4 5 6 7 8' 9 10 11 12 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) _ I KITCHEN SINK I LAVATORY ROOF DRAIN SHOWER STALL v i SERVICE/MOP SINK TOILET IURINAL 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW -7 LIABILITY INSURANCE POUCY Q- 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 application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 0 LI.1 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 u IA) W�(F�f{A N ttcv';, - LICENSE# 1 t k14- . SIGNATURE MP[c]—JP 0 CORPORATION❑# PARTNERSHIP❑.# LLC 0# COMPANY NAME ft-t 66ff4N U - /-17'(- ADDRESS P . • 35CE3 3 CITY l3aS60 r. STATE M of- ZIP OJ 13,r TEL FAX CELL celq- .Y t- Lt Pt 0 EMAIL P J t t C. oo ( f-tit ,coo-1