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HomeMy WebLinkAboutBLDP-23-002302 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �� CITY YARMOUTH MA DATE 10128/22 PERMIT# BLDP-23-002302 l' JOBSITE ADDRESS 1105 ROUTE 28 OWNER'S NAME CAPE DELI FOODS INC D OWNER ADDRESS 1105 ROUTE 28 SOUTH YARMOUTH,MA 02664-4457 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES El NO❑ FIXTURFS z 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 9 INTERCEPTOR(INTERIOR) 1 KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:drain piping 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 El 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 David lannuzzi LICENSE 10775 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ALLCLEAR PLUMBING CO INC ADDRESS Ipo#1070 f J CITY Burlington STATE IMA I ZIP 101803 I TEL 6176235533 FAX 16176233782 I CELL 16177197265 I EMAIL Idave@elgeplumbing.com (e„` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t --- -G17Y r outh 'L5— 23U'v x�� f� r,` MA DATE 10/25/2022 I PERMIT# OCT..2 6 2 J22BS1 E DDRESS 1105 Massachusetts 28 OWNER'S NAME Piccadilly Cafe and Deli BU i i_Di N DE PAP O N R DDRESS Same TELI 617 719 7265 FAX 617 623 3782 - - 4". CY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL ID PRINT CLEARLY NEW:ri RENOVATION:fl REPLACEMENT:[] PLANS SUBMITTED: YES D NO ] FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUBt CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM f .1 , DEDICATED GAS/OIL/SAND SYSTEM t DEDICATED GREASE SYSTEM 1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM �! ) DISHWASHER 1I I DRINKING FOUNTAIN t _ U FOOD DISPOSER FLOOR/AREA DRAIN 4 9 INTERCEPTOR(INTERIOR) KITCHEN SINK 1 Ii ! LAVATORY ( G ROOF DRAIN 1L ] SHOWER STALL I SERVICE/MOP SINK r TOILET URINALt._ 1 WASHING MACHINE CONNECTION I 1 i I - 1 WATER HEATER ALL TYPES " I WATER PIPING OTHER Drain pipingIII MN MEI , migimmummommumwI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 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 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 CHECK ONE ONLY: OWNER 0 AGENT E] 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 I David lannuzzi ILICENSE#110775 I 0---ISIGNATURE MPI-I JP[] CORPORATION[#I3405 IPARTNERSHIP❑#I ILLc❑#I I COMPANY NAME Allclear Plumbing Co inc I ADDRESS I po#1070 CITY Burlington 1 STATE I Ma I ZIP 101803 I TEL 1 617 719 7265 . FAX 1 617 623 3782 i CELL 1617 719 7265 i EMAIL I lave@elgeplumbing.com _ q`