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HomeMy WebLinkAboutBLDP-23-002573 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK N CITY YARMOUTH MA DATE 11/9/22 PERMIT# BLDP-23-002573 1i JOBSITE ADDRESS 225 ROUTE 28 OWNER'S NAME AMS PROPERTIES LLC P OWNER ADDRESS 225 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY❑ 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. 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 Chris Poire LICENSE 36901 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 37 Calvin Drive CITY Dennis STATE Ma ZIP 02638 TEL FAX I I CELL 17748366461 I EMAIL Imcplumber@gmaiIcom • • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � -�" ' CITY yu riM CA MA DATE /i 6—v2c)-- PERMIT# JOBSITE ADDRESS c •5 a2 1 C7 -C3 OWNER'S NAME 1Gy$ /-c 5r,f f P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL K*--- EDUCATIO ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES 0 NO 0 FIXTURES 1 FLOOR—► BSM 1 2 3 4 5 6 7 8' 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 1 DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ' KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL • ECSERVICE/MOP SINK i V � TOILET [144V URINAL 0 8 262Z WASHING MACHINE CONNECTION firuz- . , -� et fi-LA N a u WATER HEATER ALL TYPES ✓ av__ E p R r WATER PIPING _ i OTHER 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Er NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Mass husetts General Laws,and that • e on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0- AGENT 9- SIGNATURE OF OWNER OR AGENT 1.1 I hereby certify that all of the details and information I have submitted or entered regarding this application a e a rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be co li th all Pertinent provision Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L tAirre S ro r , LICENSE#0 33 5 0/ 1 —SIGNATURE __, MP 0 JP lJ/ CORPORATION❑# PARTNERSHIP❑.# LLC 0# COMPANY NAME eo,,, ? k L ADDRESS �� ..5 .— 705,E 1' 5-1---- CITY /gy2,M r`T STATE 1- ZIP $) 1 l TEL > ? Y 8 c al U FAX CELL EMAIL r ' C 44(,fWl r e 2lne3 Mel Is • (-igi Ibl,