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Home My WebLink AboutBLDP-23-004920 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - r CITY YARMOUTH MA DATE 3/8/23 PERMIT# BLDP 23 004920 °'f JOBSITE ADDRESS 223 ROUTE 6A OWNER'S NAME FITZGERALD SHEILA M TR P OWNER ADDRESS SMF REALTY TRUST 223 ROUTE 6-A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO 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 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. PLUMBERS NAME Eugenijus Jagminas LICENSE t:20 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME EUGENIJUS R JAGMINAS ADDRESS 34 ELIJAH CHILDS LN CITY CENTERVILLE STATE MA ZIP 026322112 TEL FAX CELL EMAIL CAPEANDISLANDSPLUMBING@GMAIL.COM -------FASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R �,_ VCD j1!ECITY �-,�/ J MA DATE 7J1 PERMIT# 3L P _23 7L) 9"�(2 r i M l' 0,4 BSItE PO ESS 2Z 3 i2r. OWNERS NAME Ilku i l._n p ',OWNER AIIJDRESS // TEL FAX v _ .� lifii- -OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL D RESIDENTIAL[] PRINT I CLEARLY NEW:Li RENOVATION:0 REPLACEMENT:Li. PLANS SUBMITTED: YES 0 NOp _,, I FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB INFER ?M IOW MIR EMI lint WWI IIIIIIIII NI _.. CROSS CONNECTION DEVICE .SM illIffilMNRIAMILIMINNIIIIII DEDICATED SPECIAL WASTE SYSTEM 1111.11111111111.11111111111.1 DEDICATED GAS/OI A SYSTEM - DEDICATED GREASE SYSTEM - , all111. DEDICATED GRAY WATER SYSTEM _Inman arrintist mg opal ilium; .. _ i DEDICATED WATER RECYCLE SYSTEM DISHWASHER I - DRINKING FOUNTAIN111111111111F_ a FOOD DISPOSER I FLOOR/AREA DRAIN 11111 INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN mum INN INN unitimitaiii immi umowmeuaIm mai . SHOWER STALL MIMI Ali Nil SERVICE/MOP SINK NNW NMI MIN NM INN MSMN MIN IMO NM MNMINI INN NNW TOILET ,...... i ORINAL WASHING MACHINE CONNECTION �' Mimi _.._ 'n IIIIIIrtnMIINXIHIIIIBU _NMI N INN NMI IIIIIII , WATER HEATER ALL TYPES in.an iiii-.I INN MOM I MIN 111111111111.NM NNW M. WATER PIPING Iiiii NS MIN Nil ININ MIN NM MN NMI NMNM MIN NON IIIII. OTHER INN iiii tali MI iiii initilliii INNII 11111111 NM_ _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Li NO LI IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY L 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. CHECK ONE ONLY: OWNER 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 be t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P mine provision of the Massachusetts State Plumbingod and Chapter 142 of the General Laws. C PLUMBER'S NAME S 7c, VrI'll,'4.' --� LICENSE# (892 j S NA RE MP L JPD CORPORATION I#! IPARTNERSHIPLI#I 1 LLCLJ#I 1 COMPANY NAME C J/47 mr/1/9"/ ADDRESS i V: Q /3 d)4/ ' / my 1.-- _7/4, d3dAt STATE I/'r 4 l ZIP r D&S"'t!o 2 ` TEL€ 50e Q 7¢ -0 g'e FAX CELL EMAIL �&