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Home My WebLink AboutBLDP-23-003036 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK M './ CITY YARMOUTH MA DATE 12/5/22 PERMIT# BLDP-23-003036 JOBSITE ADDRESS 29 GREENLAND CIR OWNER'S NAME HARRINGTON BRENDAN L P OWNER ADDRESS 29 GREENLAND CIR YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS--4 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❑ 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 (Michael Saurette I LICENS43E3174 I SIGNATURE MP ❑ JP 0 CORPORATION ❑# I J PARTNERSHIP ❑# I I LLC ❑# COMPANY NAME ISAURETTE BROTHERS J ADDRESS 17 Barnhouse Road 7 Barnhouse Road CITY IDennisport I STATE IMa. I ZIP 102639 I TEL I FAX I I CELL i I EMAIL Irsox555@gmail.com • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,' E pi' (U U1 v(4- MA DATE 2/i PERMIT# 27— a36 JOB DIIZESS ( "C_ee i1 Iq Y8 t✓-r' OWNER'S NAME (�S{'J(�/ !P) ivC 01202 OWNER4DFtSS TEL 77� 36s S FAX U=P RTM N _-UCCUPA CY'WT. E COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIA CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM • DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _ ROOF DRAIN SHOWER STALL SERVICE/MOP SINK _ TOILET URINAL I WASHING MACHINE CONNECTION ____^ WATER HEATER ALL TYPES X WATER PIPING OTHER [ 1 INSURANCE COVERAGE: { I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YEK—NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY ❑ 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 1 Massachusetts General Laws,and that my signature on this permit apQlication waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT ❑ `kI 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 LICENSE#3g--17_ Q l / SIGNATURE MP❑ JP `� CORPORATIONh 0# PARTNERSHIP DI LLC 0# COMPANY NAME Sgc)(e& (I J7P�I ''L( 5 ADDRESS 7 5cel(r114 005 (-1 CITY D C' 1 113 pec4-- STATE ZIP TEL FAX CELL 774 ?-70a Up� EMAIL R 50Y-EfSe' 'v1 01 r 16 q 7