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HomeMy WebLinkAboutBLDP-22-001787 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . c& CITY YARMOUTH MA DATE 9/28/21 PERMIT# BLDP-22-001787 JOBSITE ADDRESS 179 CENTER ST OWNER'S NAME Mike Leterra P OWNER ADDRESS 179 CENTER ST YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK 1 TOILET 2 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:outdoor shower 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❑ 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 Troy Gilbert LICENSE 18573 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME COASTAL MECHANICAL ADDRESS 21 L Fruean Ave CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa@coastalphc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK TOMIS To =e CITY Yarmouth Port MA DATE j09/2312021 PERMIT# Li— I'15'7 JOBSITE ADDRESS 179 Center Street -MAIN HOUSE OWNER'S NAME Michael and Leslie Letters POWNER ADDRESS 2001 E 2ND Ave Unit 10C Tampa,FL 33605 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ID RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:[ .. REPLACEMENT:Ej PLANS SUBMITTED: YES Q NOD FIXTURES 1 FLOOR-I BSM 1 2 3 4 5 I 6 7 8 9 l 10 I 11 1 12 I 13 14 BATHTUB , CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM 3 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1- DRINKING FOUNTAIN [ . FOOD DISPOSER rW a FLOOR/AREA DRAIN __... r INTERCEPTOR(INTERIOR) KITCHEN SINK ° 1 j LAVATORY 3 ROOF DRAIN SHOWER STALL 1 .. . SERVICE/MOP SINK "" TOILET .,. . . «. . URINAL ► �_ ®� ,_. .,�.- WASHING MACHINE CONNECTION 1, WATER HEATER ALL TYPES WATER PIPING y OTHER Laund Sink 1 Outdoor Rinse Station MO NM ME MR NMI MIMI all Mil ME INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG!Ch.142. YES 0 NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY 0 BOND D 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 Ej AGENT 0 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 amirate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be illsabf.kliance with al erti provision f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /7 tfAt— PLUMBER'S NAME Troy Gilbert LICENSE# 13573 IGNATURE MP0 JPQ CORPORATION 0#1PARTNERSHIPD#r W LLCE3# 4350 COMPANY NAME Coastal Mechanical ADDRESS 21 L Fntean Ave CITY South Yarmouth STATE MA ZIP 02664 1 TEL 508-737-8747 FAX CELL 508-850-6955 EMAIL Iisa@coastalphc_com