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HomeMy WebLinkAboutBLDP-23-001752 f - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ir 5` CITY YARMOUTH MA DATE 10/3/22 PERMIT# BLDP-23-001752 t' -;; JOBSITE ADDRESS 101 FAIRWOOD RD OWNERS NAME Steven Lowell P OWNER ADDRESS SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 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 ❑ 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. PLUMBERS NAME Virgilio Silva LICENSE 3/1395 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 G _= '= MA DATE 39/28/22 �� �� A-V CITY Yarmouth PERMIT# "— h 101 Fairwood Rd. JOBSITE ADDRESS OWNER'S NAME Steven Lowell POWNER ADDRESS 101 Fairwood Rd. TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:ID PLANS SUBMITTED: YES El NO® FIXTURES 7. FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB j - 1 I _ I _ 1 I CROSS CONNECTION DEVICE J 1 I _ , I DEDICATED SPECIAL WASTE SYSTEM ( _ DEDICATED GAS/OIL/SAND SYSTEM i _ ` 1 I DEDICATED GREASE SYSTEM R DEDICATED GRAY WATER SYSTEM _ ,} _ 1 , DEDICATED WATER RECYCLE SYSTEM r P 1 1 { DISHWASHER DRINKING FOUNTAIN ,a .a. FOOD DISPOSER ', — i- _ I FLOOR/AREA DRAIN d , m e f INTERCEPTOR(INTERIOR) _ 1 y j i _ , I I KITCHEN SINK LAVATORY I ROOF DRAIN 1I SHOWER STALL SERVICE/MOP SINK s TOILET URINAL WASHING MACHINE CONNECTION I I , WATER HEATER ALL TYPES 0 WATER PIPING ill I I ,. _ _ 1 OTHER , . INSURANCE COVERAGE: I have a current liability insurance policy or its substantialequivalent which meets the requirements of MG L h eq C .142. YES® NO Ej IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND El 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 ® 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 accurat t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance-wl all Pertinent pro ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Virgilio Silva LICENSE# 31395-J SIGNATURE MP El JPI CORPORATION El#Ilm.PARTNERSHIP®# COMPANY NAME Silva Plumbing&Heating ADDRESS 155 Sudbury Lane ~� — CITY Hyannis STATE MA Zip 02601 TEL SEP 2 8 2022 774-836-0176 uir iliom a hotmail.com BUILDING uLPARTMENT FAX �_ CELL EMAIL 9 9 @ ,co cIb `ck