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Home My WebLink AboutBLDP-22-004082 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/24/22 PERMIT# BLDP-22-004082 -11= JOBSITE ADDRESS 793 ROUTE 28 OWNER'S NAME SARKAR HOSPITALITY LLC P OWNER ADDRESS 105 LEXINGTON ST BURLINGTON,MA 01803 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS 3 FLOORS—, RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 , 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 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❑ NO 0 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 are 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 at 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 at 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 Donald Raymond LICENSE 25836 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME DONALD L RAYMOND ADDRESS PO BOX 522 CITY YARMOUTH PORT STATE MA ZIP 026750522 TEL FAX CELL EMAIL expertenergyhvac@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES ' 2 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1. ii=_: t=-• C(TY ((& MA DATE \ c6 ODPERMIT# - JOBSITE ADDRESS79 v l to; Q. OWNER'S NAME \ `—C.A l_ POWNER ADDRESSTC: TEE - C_ 7E f1`[FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Er EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Ey PLANS SUBMI I I ED: YES❑ NO[]f FIXTURES Z 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/OIUSAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER - FLOOR/AREA DRAIN , INTERCEPTOR(INTERIOR) , KITCHEN SINK LAVATORY - ROOF DRAIN - SHOWER STALL SERVICE/MOP SINK .. TOILET ; URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES # _ JAN 2 4 11?2 ' I WATER PIPING _. _I OTHER ,1 V —'Cr SJ / ,/ B _. . �� 1 �T(VIlrYT 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L ' NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY f OTHER TYPE OF INDEMNITY 0 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. 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 e to the t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in P ' rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. !? PLUMBER'S NAME `.)T.Y.J r){v�1V.11`1J,(�1 i� LICENSE#o t(.) GAT E MP❑ JP a' CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME F_Af... ..-- 'Q ADDRESS ��? ,�6 s k� CITYs`-tv\cv I& _ STATEW W' ZIP ( if)-b-/C TEClYt" L C? J 1 (2 FAX CELL EMAIL TC- tl1 ID v,L i`L 'A ..i- i• _r • _ at yy _ n , • t r, i _ _L • 14 t j .: • - ,t .--+-' • `il t, t ._ r_ .. .. ..._ '_. ,0.4 Itt... J 1V 1 if'.::'ff...',:: '.- . t; 'f;. . .. . 4 . . • ,r+ _ x 4, 4 . _ 1 I - - Yl.. ,K 4 T.. - ' als j , //,: n