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HomeMy WebLinkAboutBLDP-23-005537 LOBBY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 5 ., CITY YARMOUTH MA DATE 4/5/23 PERMIT# BLDP-23-005537 11-1 JOBSITE ADDRESS 518 ROUTE 28 OWNER'S NAME SANDBAR HOLDINGS LLC eD OWNER ADDRESS 518 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO m 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 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 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 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 Jonathan Gremila LICENSE 16066 SIGNATURE MP © JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JONATHAN GREMILA ADDRESS 38 McGuerty Rd CITY Harwich STATE MA ZIP 026451506 TEL FAX CELL EMAIL -T 9U MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK m CITY Yarmouth 1 MA DATE 04-04-2023 `PcnMi # 13-lX�SS3>� JOBSITE ADDRESS 518 Main St Front lobby 1 OWNER'S NAME Sandbar LLC POWNER ADDRESS u_ v TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES El NO FIXTURES 1 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 i 13 14 BATHTUB CROSS CONNECTION DEVICE In II 00.Y 'UV V I d DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/01L/SAND SYSTEM DEDICATED GREASE SYSTEM I ; DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ;annaimui _DISHWASHERinn DRINKING FOUNTAIN1111 FOOD DISPOSERLIM, MOW INN FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) I 1 i1111111_fl 1- LAVATORY nff nI w. ROOF DRAIN •SHOWER STALLus TOILETNW MB MI NMMI NM MI MI In NM MR~NM MN URINAL ill WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ilill.iiill NM WATER PIPINGk i llIniNglIWINIFo11.11111a OTHER ,,. i I 1 ..,...RRRR isimaitimminen 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 El 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. 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 'ante with ' nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Jonathan Gremila 1LICENSE# 16066 SIGNATURE MP 0 JP ElCORPORATION El#1 IPARTNERSH El#1 j LLC[-it COMPANY NAME JBG Plumbing&Heating INC I ADDRESS 118 Daluze Dr CITY Harwich STATE 1—MT1 ZIP 102645 1 TEL 1774-722-3928 FAX 1 1 CELL ... EMAIL ljgremila@yahoo.com