The URL can be used to link to this page

Home My WebLink AboutBLDP-21-003312 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 12/10/20 PERMIT# BLDP-21-003312 31 f JOBSITE ADDRESS 29 RUN POND RD OWNERS NAME MAZZONE JOHN M P OWNER ADDRESS MAZZONE DENISE E 2 MEADOW DR UPTON,MA 01568 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES i 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 ill 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 El 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. PLUMBERS NAME Roland Belanger LICENSE 1,0817 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ROLAND M BELANGER ADDRESS 125 WEST RD CITY PASCOAG STATE RI ZIP 028592901 TEL FAX CELL EMAIL 69 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES �- Yes No IA £el ✓r /IS THIS APPLICATION SERVE AS THE PERMIT Ei A L L S � £ J I/( FEES$ PERMIT# PLAN REVIEW NOTES Nw"r Pi(144; 171,0 12t )/f i 0/e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK P CITY/TOWN YG'YVfl 'l MA DATE / 'd /ZUZ C) PERMIT#7LDP- 07-/ P31 La � 9 t.U-t t��) Ci �c�d JOBSITE ADDRESS �- OWNER'S NAME 7)V)1 f U'"e�r 1 t OWNER ADDRESS ` 1 (,t i 1 �O tl� ��C C (i TELST>5- 1C. f 'r Z y iFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL tad' PRINT CLEARLY NEW:❑ RENOVATION:Er REPLACEMENT: ❑ PLANS SUBMITTED: YES 0 NO L FIXTURES 1 FLOOR 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE%MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES '[3Llit_LI:;C ut "r ; Mk.. WATER PIPING - 14 OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Igi NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I" OTHER TYPE OF INDEMNITY ❑ BOND ❑ I 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 ❑ AGENT 0 I hereby certify that all of the details and information I have submitted or entered regarding this application are t d accurate to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in I. ce P 'nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R6 lld �t �(1Y1'Ce-e- LICENSE# f U f I ' 3.1,,c,kkr MP Er JP 0 CORPORATION 0# PARTNERSHIP 0# COMPANY NAME 41C01. ! I anc y-t L f i T ADDRESS 125 Ijf(Q.S f- f ca_d CITY J STATE Kr-- ZIP L Z a- TEL 'IL I - 11 G J I I FAX CELL /L/- -e `{r EMAIL V 01 bpi l i lib 1 rl �a' VSCY 1 n •y`Q } ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT HIS kin J £ IJ)(yJ FEES$ 1PERMIT# /I hr /a nn ,0 PLAN REVIEW NOTES (Zl l l 2_O-zo MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY IYARMOUTH JOBSITE ADDRESS 129 RUN POND RD MA DATE I12110120 I PERMIT# BLDP-21-003312 I_ I OWNERS NAME IMAZZONE JOHN M P OWNER ADDRESS IMAllONE DENISE E 2 MEADOW DR UPTON,MA 01568 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL Ej PRINT CLEARLY NEW: ElRENOVATION:��] REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO El 8 9 10 11 12 13 14 FIXTURES z FLOORS-4 BSM 1 2 3 4 5 6 7 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE 1 DISHWASHER 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: YES 0 NO El have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. 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. 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. PLUMBERS NAME (Roland Belanger I LICENSEIt0817 I SIGNATURE MP 0 JP 0 CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I I COMPANY NAME IROLAND M BELANGER I ADDRESS I125 WEST RD CITY IPASCOAG STATE IRI I ZIP 1028592901 I TEL I FAX CELL EMAIL I 1.%