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Home My WebLink AboutBLDP-23-001011 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/25/22 PERMIT# BLDP-23-001011 ' JOBSITE ADDRESS 248 CAMP ST UNIT B5 OWNER'S NAME JACOVIDES BETTY TRS P OWNER ADDRESS JACOVIDES GEORGE L 5 WEST ST ARLINGTON,MA 02476-7135 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • 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/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 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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❑ 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 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 `" , - •CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK , °Iss.4 CITY �s - ?-3CI fr.+ ( MA DATE 18/24/22 PERMIT# � ` / .�? 4, •UG 2 .DJ ' SS 248 camp street unit-B-5 OWNER'S NAMEITammy Jacovids BU PING D "o-, SS'same as the above TELi FAX• e- OCCUPANCY TYPE COMMERCIAL w, J EDUCATIONAL fl RESIDENTIAL PRINT RENOVATION: I REPLACEMENT: ,i PLANS SUBMITTED: YES€,• NOi I CLEARLY NEW: r FIXTURES 1 FLOOR-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ _ ___ m __ _... __- ___ _ CROSS GONNECTION DEVICE 0 DEDICATED SPECIAL WASTE SYSTEM Milli DEDICATED SYSTEM — _ _ __ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEMnig n w _ __.. .. DISHWASHER .. _a DRINKING FOUNTAIN - w. - FOOD DISPOSER FLOOR I AREA DRAIN MI ; INTERCEPTOR(INTERIOR) KITCHEN SINK �� : , LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 1 w URINAL __. _ , WASHING MACHINE CONNECTION — WATER HEATER ALL TYPES WATER PIPING �� , - ii , , , j 1 , OTHER ... MINI 11111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIMB INN MIN ' 112 INSURANCE COVERAGE: I have a current Rabffitv insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO . W YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a_� OTHER TYPE OF INDEMNITY , ', BOND i CV/MEWS 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 , ' AGENT l_ SIGNATURE OF OWNER OR AGENT I hereby certify that ail 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 comp'ance . f P in t provi on of the Massachusetts State Plumbing Cade and Chapter 142 of the General Laws. PLU ER'S NAME jJoselin C Sanchez 'd� "v . +G 't—� I ILICENSE#�31804 SIGNATURE MP, . ? JP s . CORPORATION;_ ;#[ PARTNERSHIP ;#; I LLC # COMPANY NAME Giovanni plumbing and heating I ADDRESS I n/a CIIYIWest Yanrouth STATE l Ma I ZIP 102673 ; TEL 1508-360-1389 FAX 1 CELL'508-360-1389 I EMAIL Iplumbing657@gmail.com I