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HomeMy WebLinkAboutBLDP-23-005536 i 10 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK c, CITY !YARMOUTH MA DATE 4/5/23 PERMIT# BLDP 23 005536 '" OWNER'S NAME HANUMAN DARSHAN LLC I I � JOBSITE ADDRESS 961 ROUTE 28 P OWNER ADDRESS 707 SOUTH WASHINGTON ST NORTH ATTLEBORO 02670-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT 111 CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES NO FIXTURES 1 FLOORS-4 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 10 -DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK !a LAVATORY 44 _ROOF DRAIN . SHOWER STALL SERVICE/MOP SINK TOILET 44 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 m 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 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 (Derek Happas I LICENSE 30318 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑# 1 I COMPANY NAME IDEREK P HAPPAS I ADDRESS 142 Old Town Way I CITY (Hanover I STATE IMA I ZIP 102339-1442 I TEL FAX I I CELL I I EMAIL derekhappas@gmail.com • 1,(0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK No •CITY 'ZI)ti14 � vt4O1 t' -MA DATE " l'026.23 PERMIT# 2 3`oO Sc JOBSITE ADDRESS 9x2 ) W114,4',n.l ST (24,ui S OWNER'S NAME OWNER ADDRESS l(g s — TEL TEL 568-186/ateira, FAX TYPE OR OCCUPANCY TYPE COMMERCIAL" EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:l" REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES 1 FLOOR-4 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER • FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY L/LI ROOF DRAIN SHOWER STALL • SERVICE I MOP SINK TOILET L,1 t..) URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: i 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 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 ' Massachusetts General Laws,and that my signature on this permit application waives this requirement. G� N J ins yk P&s A/3 CHECK ONE ONLY: OWNER ' AGENT 0 SIGNATURE OF OWNER OR AGENT I 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 'n t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# 303).g GN MP❑ JP CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME Yr) ADDRESS t102 01-t lotok.) wA k CITY 1•- AX'V e- STATE PA - ZIP 0 V33 cJ TE 17—93y 3 J I< L FAX CELL EMAILZL �iAP P An(IL- ('Q 1�/\