HomeMy WebLinkAboutBLDP-23-004033 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 1/23/23 PERMIT# BLDP-23-004033
'1!) JOBSITE ADDRESS 121 BOB-O-LINK LN
OWNER'S NAME ICONTOS HARRIS
P OWNER ADDRESS 121 BOB 0 LINK LN WEST YARMOUTH,MA 02673 I TEL I
TYPE OR OCCUPANCY TYPE COMMERCIAL 0
PRINT RESIDENTIAL El
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO
El
FIXTURES + 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 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1
LAVATORY
ROOF DRAIN
SHOWER STALL
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 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
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 (Kenneth Duarte I LICENSIIA11012
SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# I J PARTNERSHIP ❑# I J LLC ❑#
COMPANY NAME I I ADDRESS 137 Collins ave
CITY 'Centerville I STATE IMA
I ZIP 1026322345 I TEL ' I
FAX I I CELL I I EMAIL
1
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY
FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE El CI
FEES$ PERMIT# Nz k. AL bp L 3 )Y
PLAN REVIEW NOTES