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Home My WebLink AboutBLDP-22-005786 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK atyf, CITY YARMOUTH MA DATE 4/11/22 PERMIT# BLDP-22-005786 1=1= JOBSITE ADDRESS 226 ROUTE 28 OWNER'S NAME SIA DEVANG LLC P OWNER ADDRESS 226 ROUTE 28 WEST YARMOUTH,MA 02673 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 13 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 13 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 'Anthony Coughlan I LICENSE't6965 I SIGNATURE MP ❑ JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# I COMPANY NAME 'ANTHONY D COUGHLAN I ADDRESS 1469 LINCOLN ST CITY 'FRANKLIN I STATE IMA I ZIP 1020384271 J TEL I FAX I I CELL ' I EMAIL 'tony@alphamanagementcorp,com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -r __T:1�_lq EcRrW E D 1/4' -. _ MA DATE PERMIT# • 2 2 -S�V4 1 A•r-R Z5 L �L A R SS ��lA�/c! ."'tCi i vl S4, 1q' >1 �a-fim Oat-11 OWNER'S NAME At pi/� lAc ;�aY,e92� r 15. 3 .____ OWNER AD R s l ( l BeCL'i. i Sf TEL 1 t � TEL�'i�(- 73 D>-5 vice�' FAX 6 L 7-736-Ca 3 cat, L_D!NG DEPARTMENT 1' ile-I'ti✓lk , tV I A- 02`'i"l 6, L PE COMMERCIAL] EDUCATIONAL ❑ RESIDENTIAL❑ PRINT i CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:cZ PLANS SUBMITTED: YES❑ NO❑ 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/OIL/SAND 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 t J \—€ -\-c& ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL 1 ' . \per WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESYA NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 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 CHECK ONE ONLY: OWNER 0 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 r • ' n of 'ie Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME .A vl-Ytii Vt,t' C4L�.q/Yt. CUY\.. LICENSE# t 5c1 6 t_ —� UU J .---- S RE MPti JP❑ CORPORATION E'# PARTNERSHIP❑# LLC❑# COMPANY NAME Alpha( AA ab/CY jeirr ok Gyr. ADDRESS 124 9 " eCt_C.-,i,t S- - Sr 0 a4 CITY '-e-OrN/0_,CleA. _. _ STATE A11 ZIP 1C2-��L{� TEL 61 7 -730 ' 5dS FAX k\ 1 7�,0- t g 3 CELL I (- 79q - 112,0 EMAIL`-Un c ti