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Home My WebLink AboutBLDP-23-002740 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ei CITY YARMOUTH MA DATE 11/16/22 PERMIT# BLDP-23-002740 E, ' JOBSITE ADDRESS 20 HEMEON DR OWNER'S NAME Robert Salemme P OWNER ADDRESS 20 HEMEON DR WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El 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 liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 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 'Anson Celin i LICENSEI32655 1 SIGNATURE MP ❑ JP 12 CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# COMPANY NAME 'ANSON CELIN ADDRESS 126 Capt. Blount Rd CITY (South Yarmouth I STATE IMA I ZIP 102664 I TEL FAX I I CELL ( I EMAIL (ansoncelin@yahoo.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �__ ' CITY (Uz�SJ� L( nin'Lty14t { MA DATE i /- I L--2...I— PERMIT# JOBSITE ADDRESS 11 c 4-4 AA...e v,-1 [}; OWNER'S NAME 2 OWNER ADDRESS Z S t,j{c'.4 k L u rvt TEL Sat-Z ZO-c//7.FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-+ BSM 1 J 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 :�rr "' 7 SERVICE/MOP SINK f. E c TOILET -T URINAL ' NOY '6 2022 i WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING pIN ut�r�I�'E T OTHER _ ay._`" 1 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY NS OTHER TYPE OF INDEMNITY 0 BOND 0 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 application waives this requirement. 1 CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT I 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 com Iiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /� PLUMBER'S NAME/ ` '" a_'— 6/2„._ - LICENSE# 5 j- SIGNATURE MP❑ JP V Z.CORPORATION 0# PA RTNERSHIP❑.# LLC❑# COMPANY NAME a\1 11 e;LA m b i.n f) ADDRESS 2-6- fzi i .7 J 1 C vi)4, R 0 CITY STATE ZIP 02-G-64 TEL FAX CELL 54F=Z ki,-t_t' 1 2_ EMAIL t'"IrA0-1(-l in 0