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HomeMy WebLinkAboutBLDP-23-005484 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/4/23 PERMIT# BLDP-23-005484 VIWA JOBSITE ADDRESS 46 OAK GLEN VILLAGE OWNER'S NAME MCDONOUGH DANIEL P P OWNER ADDRESS MCDONOUGH LYNNE L 25 HARWICH RD LONGMEADOW,MA 01106-1207 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ 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 1 SERVICE/MOP SINK TOILET 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 Kurt Mello LICENSE#t2668 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KURT E MELLO ADDRESS 26 Cedar Street CITY Woburn STATE MA ZIP 1801-0000 TEL FAX CELL EMAIL melloplumbing@aol.com 1,1104111 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1111 '" Ifil` vrr ! �f32 PERMIT L3 L}(,�.S Z>y' f MA DATE off EAIDRESS B i A 3 L3k l7c,...K tr/e OWNER'S NAME OW Ai DRESS Same TELI6175937104 FAX ,II n C; r)EP`RTMENT TYPE OR- • -°k i Y TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL Ei PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 NO FIXTURES 1 FLOOR—+ BSM 1 2 A3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I - �� i § 1. I CROSSCONNFCTIQNDFVICF C1l ,..® ,_ �. ;` DEDICATED SPECIAL WASTE SYSTEM I W I ,_... ti €I i _ t ti DISHWASHERDEDICATED GREASE SYSTEM - ... 11 ., FLOOR AREA DRAIN I iw INTERCEPTOR(INTERIOR) -,, E -sing 5 LAVATORY ROOF DRAIN E ){ TOILET liniaillIMMIMINIMMInlialliallinininillilinnallt URINAL1.1111.1111111•11.111.111111MMIMIIIIIIM s MK WASHING MACHINE CONNECTION ' l INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ei 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 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 El AGENT 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 c mpliance with p�Pertinentinjnt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � """�` PLUMBER'S NAME Kurt Mello LICENSE# 12668 SIGNATURE MPEl JP D. CORPORATION El# JPARTNERSHIPD#1 j LLCE.,.".,#L4505 J COMPANY NAME Newpro Plumbn ADDRESS 26 Cedar Street CITY Woburn . STATE MA ZIP L01801 TEL 6177507598 FAX CELL EMAIL Melloplumbing@aol.com "