HomeMy WebLinkAboutBLDP-23-000129 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
w, -el CITY YARMOUTH MA DATE 7/8/22 PERMIT# BLDP-23-000129
w JOBSITE ADDRESS 56 GREENLAND CIR OWNER'S NAME Ben Grew
P OWNER ADDRESS 56 GREENLAND CIR YARMOUTH PORT,MA 02675-2183 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL CO
PRINT
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑
FIXTURES • 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/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 2
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION
WATER HEATER
WATER PIPING 1
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❑ OTHER TYPE OF INDEMNITY❑ BOND 0
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 3,1395 SIGNATURE
MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN
CITY HYANNIS STATE MA ZIP 026012462 TEL I
FAX ( 1 CELL I EMAIL virgiliomga@hotmail.com
8D,0
__, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
tipaa MA DATE F/07/22 PERMIT#
L Q 7O QE A D SS 56 Greenland Circle OWNER'S NAMEpen Grew
BU .Ir4G D�P� TEL FAX
END SS 56 Greenland Circle
ev
TYPE OR PE COMMERCIAL® EDUCATIONAL ID RESIDENTIAL El
PRINT
CLEARLY NEW:Ej RENOVATION:® REPLACEMENT:0 PLANS SUBMITTED: YES® N00
FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I
1._` 'i
CROSS CONNECTION DEVICE I
DEDICATED SPECIAL WASTE SYSTEM I 1 I
DEDICATED GAS/OIL/SAND SYSTEM 1 �, �I. �e p
DEDICATED GREASE SYSTEM -_
DEDICATED GRAY WATER SYSTEM I
DEDICATED WATER RECYCLE SYSTEM 1 _ ___A _ F , , I 1
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER _ _.�.s .'' ,. IIs �1�...._� I , w
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) I
KITCHEN SINK
LAVATORY , .. 2 . 1 _
ROOF DRAIN ;i
SHOWER STALL 1 I _... f
SESERVIIC.E/MOP SINK ®,-� i
ILE
_ _
URINAL I �, '..__ .- ___ 1 �1 � I ._.__- ` ___
WASHING MACHINE CONNECTION , R1 11
WATER HEATER ALL TYPES 1 I
WATER PIPING I 0 _ J
OTHER I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY El BOND 0
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 0
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 be t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance w' • nent provisi• •f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Virgilio Silva LICENSE# 31395-J -- — _ , -
MP El JP El CORPORATION0# IPARTNERSHIP El# LLC #
COMPANY NAME Silva Plumbing&Heating ADDRESS 155 Sudbury lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX CELL 774-836-0176 EMAIL virgiliomga@hotmail.com