HomeMy WebLinkAboutBLDP-23-005257 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
liWi,.. ,, CITY YARMOUTH MA DATE 3/24/23 PERMIT# BLDP 23 005257
=3s JOBSITE ADDRESS 57 KENCOMSETT CIR OWNER'S NAME ARAUJO RICHARD M
P OWNER ADDRESS ARAUJO CLAUDINE M 57 KENCOMSETT CIR YARMOUTH PORT,MA 02675 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑
PRINT
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES El 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 1
WATER HEATER
WATER PIPING
OTHER 1
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El 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 Richard Araujo LICENSE t0617 SIGNATURE
MP ❑ JP 0 i CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME RICHARD M ARAUJO ADDRESS 156 MAIN ST
CITY SOUTHBOROUGH STATE MA ZIP 01772-1432 TEL
FAX CELL EMAIL sciapa@aol.ocm
g'o . ob
,. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
{_�� CITY-- �.', dv MA DATE ( . PIT# ._ZJ" C1 Z S�'
��/tot, .I D.RE''.S C7 / r6Y14St5W LC = OWNER'S NAME
1. OLWNER ADDRE S /SZ� A//H ;y', iz
B ILDING D esulmoENT /p TEL �.•e< .1 2[ ')38 FAY.oy X�"
E COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL.
PRINT
CLEARLY NEW:❑ RENOVATION REPLACEMENT:❑ PLANS SUBMITTED: YES❑ N_
FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 BATHTUB 14
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM - _
DEDICATED GREASE SYSTEM _
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM _
DISHWASHER I _ _�
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK I
LAVATORY
•
ROOF DRAIN -
SHOWER STALL
SERVICE/MOP SINK
1 TOILET
URINAL
WASHING MACHINE CONNECTION ,
WATER HEATER ALL TYPES
WATER PIPING
OTHER -
3/1 S ,N1/- [
NCE COVERAGE:
NSU
I have a current liability insurance policy or its substantiallequ a ent which meets the requirements of MGL Ch.142. YES
El NOA(
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
1/ Massach a General La s,and that my signature on this permit application waives this requirement.
• SIGNATURE F OWNER OR AGENT CHECK ONE ONLY: OWNER AGENT El
I hereby certify that all of the details and information I have submitted or entered regarding this application are tr and ccurate to the be of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp an it all ertinent ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. g
PLUMBER'S NAME
LICENSE#Mll 0r1• IGNATU
M PA JP El A/ CORPORATION❑# PARTNERSHIP❑.# LLC #
COMPANY NAME 12-lcl14' ✓� ..-) ❑
�,,q ADDRESS / 1`W/yj�,/ ,Sli
CITY � ��rlolw
oft.... STATE>""�'{'7�- ZIP C��' 7 7
FAX _ TEL . 62_ (;Y(9: '
CELL EMAIL SC/464