Loading...
HomeMy WebLinkAboutBLDP-22-001786 GARAGE MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/28/21 PERMIT# BLDP-22-001786 e JOBSITE ADDRESS 1179 CENTER ST OWNER'S NAME Mike Leterra P OWNER ADDRESS 179 CENTER ST YARMOUTH PORT,MA 02675 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 173 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES 1 FLOORS-0 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 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❑ 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 I LICENS4#0573 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# I COMPANY NAME !COASTAL MECHANICAL I ADDRESS 121 L Fruean Ave CITY 'WAREHAM I STATE IMA I ZIP 1025711324 I TEL I FAX ! I CELL I ( EMAIL llisa@coastalphc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK elm_: CITY Yarmouth Port MA DATE PERMIT# 22- 1 7 8(o JOBSITE ADDRESS 179 Center Street Garage OWNER'S NAME Michael and Leslie Lettera P OWNER ADDRESS 2001 E 2ND Ave Unit 10C-Tampa,FL 33605 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL] EDUCATIONAL El RESIDENTIAL ID PRINT CLEARLY NEW:Q RENOVATION:Q REPLACEMENT:0 PLANS SUBMITTED: YES Q NO 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM G DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER i DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN NM INN MR MB NMI NMI INN 111111111111111 NMI MIMI NMI MN NM NMI INTERCEPTOR(INTERIOR) IMP MOM Ili 11111111 MI III 11111111111111 III III AIM INN MI MIN MIN KITCHEN SINK LAVATORY • a [ ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 F, URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1_.E 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 Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /2d r, g - PLUMBER'S NAME Troy Gilbert LICENSE#1 13573 GNATURE MP0 JP CORPORATION 0#1PARTNERSHIP[#f LLC 0# 4350 COMPANY NAME Coastal Mechanical ADDRESS 21 L Fntean Ave CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747 FAX I 1 CELL 508-850-6955 I EMAIL lisa@coastalphc com