HomeMy WebLinkAboutBLDP-22-005856 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 4/13/22 PERMIT# BLDP-22-005856
JOBSITE ADDRESS 135 SOUTH SHORE DR UNIT 34 OWNER'S NAME Nancy Andric
P OWNER ADDRESS 20817-2056 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:m PLANS SUBMITTED: YES NO❑
FIXTURFS • 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
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1
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 IJoselin Sanchez LICENSE 3tI804 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME JOSELIN C SANCHEZ ADDRESS 108 BAYVIEW ST
CITY WEST YARMOUTH STATE MA ZIP 1026738211 TEL
FAX CELL EMAIL giovannisanchez524@yahoo.com
.i , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK /0
v" , , th I MA DATE(413-22 (PERMIT# Z Z— SI 5�
APR 1J SITE AD R S 1135 south shore Dr.unit 34 I OWNER'S NAME(NancyAndric
2022
OWNER RE (same as the above I TEL( JFAXI J
B E OR G JEPA T
CoC_Curwic I E COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL Q
PRINT
CLEARLY NEW:0 RENOVATION:Q REPLACEMENT Ej PLANS SUBMITTED: YES Q NOD
FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE — , i
DEDICATED SPECIAL WASTE SYSTEM 11
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM I
DEDICATED GRAY WATER SYSTEM Milli
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN lila .,1
FOOD DISPOSER
FLOOR!AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK ,I
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK nijil
TOILET 1 I
URINAL I
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES I
WATER PIPING
OTHER I
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 E7
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
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 1:: AGENT 0
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(Joselin C Sanchez (LICENSE# 31804 SIGNATURE
MP0 JP CORPORATION 0#I 'PARTNERSHIP ED#I JLLCED#I J
COMPANY NAME(Giovanni plumbing and healing I ADDRESS' N/A I
CITY West Yarmouth (STATE 1 Ma (ZIP 102673 I TEL 1508-360-1389
(
FAX (
1 CELL 1508-360-1389 1 EMAIL (plumbing657@gmail.com