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Home My WebLink AboutBLDP-22-004179 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 — CITY YARMOUTH MA DATE 1/26/22 J PERMIT# BLDP-22-004179 JOBSITE ADDRESS 63 ABELLS RD OWNERS NAME SYKI LLC P OWNER ADDRESS 63 ABELLS RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 1 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 1 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 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 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. PLUMBER'S NAME ryan ledin LICENSE 3i1014 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC Ott COMPANY NAME LEDIN PLUMBING ADDRESS 8 harvest lane CITY Berkley STATE [MA ZIP 02779 TEL FAX CELL EMAIL LEDIN617@YAHOO.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES S PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y CITY !west armouth J MA DATE tt [ /15/22 _ PERMIT # JOBSITE ADDRESS '63 Abells OWNER'S NAMEDan Rosman P �_. ; . , � � . �� ar. OWNER ADDRESS [60 ,,,wx , ,IM ywi �clan��iEL - %�FAx TYPE OR OCCUPANCY TYPE COMMERCIAL f I EDUCATIONAL in RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: v REPLACEMENT: 1 PLANS SUBMITTED: YES Li NOD FIXTURES Z FLOOR-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 11111.1 1 1 1 11.., ;__. ..,. 1 ... CROSS CONNECTION DEVICE - '` ~ DEDICATED SPECIAL WASTE SYSTEM � DEDICATED GAS/OIL/SAND SYSTEM __ .F ._, 1 DEDICATED GREASE SYSTEM t �` V �� DEDICATED GRAY WATER SYSTEM _i., , .„._ _ r____It_ ,, , ._71_, _:_ilir:—111____, , 1 a. DEDICATED WATER RECYCLE SYSTEM ir: 1 DISHWASHER II 1 _ DRINKING FOUNTAIN � _ �! 2 MHOS 111.11111111111111111111111i I0 _ FOOD DISPOSER �- 1 , .�. .1111.1 r , r- -- FLOOR / AREA DRAIN 1 (12 _ I , INTERCEPTOR (INTERIOR) 4; r i1 i ! f KITCHEN SINK LAVATORY 1 r-..-.1 it _.: 1 ROOF DRAIN =ll'i _ SHOWER STALL �� SERVICE / MOP SINK NMI M Miliiiiiiiiiiiiiiiir _ ---lf � TOILET E _ ..:.:' «�p . _. ...- - ::::: - �.,+.4•.....:w.,,Yo'u.L URINAL` _ ' ! t 5 .-. ..k .� .: �. al':'. .I a 4f .rs WASHING MACHINE CONNECTION LI >E , WATER HEATER ALL TYPES WATER PIPING _ ,` r OTHER i I OM 1 ;N.E 1.11111111.MI INSURANCE COVERAGE'. I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO izj 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 Massachu s Gene ' ws, and that my signature on this permit application waives this requirement. = ,° CHECK ONE ONLY: OWNER AGENT i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru= and accur e to th est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co • •I':nce ' Pe ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - PLUMBER'S NAME .R an Ledin LICENSE # gyp % SIGNATURE MPO JP Lij CORPORATION # MyjPARTNERSHIPLJ# LLCEJ#ijJ COMPANY NAME I Ledin Plumbin ADDRESS E 8 Harvest Lane CITY[BerkleyjSTATE MA ZIP -02779 . TEL �� @IltllF lltl!SO4fe��lK3� FAX E CELL - _� EMAIL Iedin617 shoo.com ., �. .._,�..,�....�.,_........� .. �n � 1 0