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HomeMy WebLinkAboutBLDP-23-003864 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/17/23 PERMIT# BLDP 23 003864 mi JOBSITE ADDRESS 76 WINTER ST OWNERS NAME LAURIA THOMAS J P OWNER ADDRESS LAURIA ELIZABETH A 76 WINTER ST YARMOUTH PORT,MA 02675-1246 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO FIXTURES 1 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 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 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 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. PLUMBERS NAME 'Richard Olsen LICENS4fA335 SIGNATURE MP JP El ❑# I I PARTNERSHIP 0# I LLC ❑# I © COMPANY NAME IOLSEN PLUMBING&HEATING ADDRESS 1357 Hokum Rock Road STATE MA ZIP 102638 I TEL 15083855290 CITY Dennis FAX CELL EMAIL 'OFFICE@OLSENPLUMBING.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,7M1—cr — t1 _ CITY \CA�MOsm`�C)! t MA DATE[1I1\\-Lb L3 I PERMIT# 2')- 3g�y JOBSITEADDRESS -I0 ,+`lceY SM��et OWNERS NAME POWNER ADDRESS TEL FAX) i TYPE OR OCCUPANCY TYPE COMMERCIAL ill EDUCATIONAL ❑ RESIDENTIAL, ] PRINT CLEARLY NEW:❑ RENOVATION:D REPLACEMENT. I PLANS SUBMITTED: YES El NO FIXTURES-1 FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I -. CROSS CONNECTION DEVICE [ j ( DEDICATED SPECIAL WASTE SYSTEM j j1�i Y [ i DEDICATED GAS/OIL/SAND SYSTEM 011 MI r 1 _ W! . ' DEDICATED GREASE SYSTEM 1 i . DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 1P l{ DISHWASHER i : ( �_ �l FOOD DISPOSER FOUNTAINDRINKING f l�j f ,= 1111111_ FLOOR I AREA DRAIN .1111111 INTERCEPTOR(INTERIOR) 1I if1 , KITCHEN SINK 1€ . '1I I 1 LAVATORY [,. 1 C 1 .1. ..._ ROOF DRAIN I, r SHOWER STALL " '` TOILET SERVICE/MOP SINK mil ;I!.� ! M. �! URINAL . ], M11.1 ;111 WASHING MACHINE CONNECTION 1111111 11111111111111111111. , � I_ WATER HEATER ALL TYPES !Illi mmirmamow I r WATER PIPING raw ji [^ ` i, , OTHER �� � �'' _ .n I ill"lilt 1 a--.-LL-LL.-I i 3 3 ' mp 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ej NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE OF INDEMNITY fl BOND[j 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 D 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 o•v' nowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ' e wit e ent4 ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ��� PLUMBERS NAME RICHARD OLSEN LICENSE#a M10335 SIGNATURE MPO JP® CORPORATION El# 2166 PARTNERSHIP❑# LLC # COMPANY NAME OLSEN PLUMBING&HEATING I ADDRESS 357 HOKUM ROCK ROAD CITY DENNIS STATE MA ZIP 02638 TEL 508-p85-52Q0 J ri4CCEi FAX 508-385-6963 CELL EMAIL v E JAN 13 2023 BUILDING DEPAR1:VENT By._