Loading...
HomeMy WebLinkAboutBLFP-21-006141 _ y Writ. DZA 1/1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK n, et CITY YARMOUTH MA DATE 4/23/21 PERMIT# BLDP-21-006141 I' JOBSITE ADDRESS 159 CHIPPING GREEN CIR OWNER'S NAME PODARAS DIANE TR P OWNER ADDRESS (THE GAIL P PODARAS IRR TRUST P 0 BOX 646 SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: El RENOVATION:0 REPLACEMENT:ElPLANS SUBMITTED: YES❑ NO El FIXTURES z FLOORS--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 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 0 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 (Kevin Decoteau I LICENSEI136532-m I SIGNATURE MP © JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I COMPANY NAME I I ADDRESS 138 Powhatan Rd CITY (South Yarmouth I STATE IMA I ZIP 102664 I TEL I FAX CELL I I EMAIL I DiBenedetto, Mark From: Zachary Thompson <hamham1000@yahoo.com> Sent: Thursday, November 10, 2022 2:51 PM To: DiBenedetto, Mark Subject: Replacing contractor 59 chipping green Cir south Yarmouth 02664 Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. We would like to replace KMD plumbing as our contractors at 59 chipping green Cir south Yarmouth 02664 MA Sent from my iPhone 1