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HomeMy WebLinkAboutBLDP-23-001838 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • CITY YARMOUTH MA DATE 10/6/22 PERMIT# BLDP-23-001838 I" vt JOBSITE ADDRESS 9 CEDAR ST OWNERS NAME WRIGHT MICHAEL P TR P OWNER ADDRESS THE WRIGHT 2008 IRR TRUST 46 WEDGEWOOD RD WORCESTER,MA 01602 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES I FLOORS-4 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❑ 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 Virgilio Silva LICENSE 3t1395 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga@hotmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l'�' .4_ tW MA DATE 10/05/22 PERMIT# LI i 8 3 2 �' OCT emslintDDREss 9 Cedar St. OWNER'S NAME Michael Wright INCWiN R etettpS 46 Wedgew,Worcester-MA TEL FAX I IID C� t By E COMMERCIAL El EDUCATIONAL ® RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES 0 NOEl FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 i 1 CROSS CONNECTION DEVICE ! I I =1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 1 A [ I DEDICATED WATER RECYCLE SYSTEM 1 1 I , I DISHWASHER DRINKING FOUNTAIN I. FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) j 1 i I , i 1 I KITCHEN SINK n� _ LAVATORY ;'I 1 , . .1 ROOF DRAIN SHOWER STALL PI I � SERVICE/MOP SINK TOILET URINAL i It_ 1 I 1 - I _ WASHING MACHINE CONNECTION NMI1 1 _ ----- 1 -- - WATER HEATER ALL TYPES WATER PIPING l 1 1 OTHER j 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO ID 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. CHECK ONE ONLY: OWNER El 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 my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Virgilio Silva LICENSE# 31395-J RE MPO JP CORPORATION 0#, PARTNERSHIP®# I LLCEl# __ COMPANY NAME SilvaPlumbing&Heating ADDRESS 155 Sudbury Lane CITY Hyannis STATE MA ZIP 02601 TEL FAX ' CELL 774-836-0176 EMAIL wirgiliomga@hotmail.com