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Home My WebLink AboutBLDP-23-005785 #31 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/19/23 PERMIT# BLDP-23-005785 JOBSITE ADDRESS 1�&18 411//affit OWNER'S NAME BRIGGS THOMAS J P OWNER ADDRESS BRIGGS PAMELA A 70 MANDALAY RD LEE,MA 02138 TEL TYPE OR OCCUPANCY TYPE 3 / COMMERCIAL ❑ RESIDENTIAL El 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 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 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. PLUMBER'S NAME Kesuqs Lopez LICENSE 1;6301 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KESUQS LOPEZ ADDRESS 107 Meetinghouse Rd CITY Mashpee STATE MA ZIP 026492617 TEL FAX CELL EMAIL klopez2k11@gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _= I= CITY Yairni 0 i,t, I/\ MA DATE 11/10 0 S PERMIT#2 t 7's=3- JOBSITE ADDRESS IQ SAC \flew ht -31 OWNER'S NAME OWNER ADDRESS ite4 CO. k- I CIA) li. TEL& 77 �' o2 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ° PRINT CLEARLY NEW:❑ RENOVATION:, REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-4 BSM 1 J 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 I. ROOF DRAIN ----- SHOWER STALL I Ir2 C SERVICE/MOP SINK URINAL Ht'R 1 ."'t�l WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i DING DEPARTMENT WATER PIPING ey_=OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES gl NO ❑ 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LU 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 w'h all Pertinent pro ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME (5;v a.." �=� Z LICENSE# j�,3O j SIGNATURE MP I JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME V ,� HOf.� �/' � � I L��1''I�' ADDRESS 101 ��,��,Oak R t� CITY C QS1'1' C C . STATE W11-4 ZIP Vv26 TEL TEL(77 ) e -- 6 o FAX �� 1 / �// r �� CELLL�1`�) .. ,b�7� EMAIL • /Z (-:�; Z:aC ktiftjii4o, / GC) • I LID.6D