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HomeMy WebLinkAboutBLDP-23-000065 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 'YARMOUTH I MA DATE I7/6/22 I PERMIT# BLDP-23-000065 JOBSITE ADDRESS 1174 BAYVIEW ST I OWNERS NAME[JEWELL RONALD p OWNER ADDRESS 'REILLY SANDRA 1101 WORCESTER RD FRAMINGHAM,MA 01701 I TEL I I TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ PRINT RESIDENTIAL ED CLEARLY NEW: ❑ RENOVATION:co REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES • FLOORS-0 8SM 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 1 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:Laundry sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES m 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 Joshua Ferreira LICENS:16948 MP © JP ❑ SIGNATURE CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Ferreira plumbing and heating ADDRESS 2 Hathaway rd. CITY STATE ZIP 02779 TEL 7742632391 FAX CELL 7742228219 EMAIL