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Home My WebLink AboutBLDP-22-004228 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/28/22 PERMIT# BLDP-22-004228 ti- JOBSITE ADDRESS 1314 ROUTE 28 OWNER'S NAME PATEL MOHANVHAI TRS P OWNER ADDRESS JALARAM VANI REALTY TRUST 1314 ROUTE 28 SOUTH YARMOUTH,MA 02664 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURFS 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 41 40 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 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 El 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 Peter Riva LICENSE 13447 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PETER E RIVA ADDRESS 9 BAYVIEW ST CITY MARSHFIELD STATE MA ZIP 020502906 TEL FAX CELL EMAIL peterriva@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Ves No THIS APPLICATION SERVE AS THE ❑ FEES S PERMIT# PLAN REVIEW NOTES • MASSACH US ETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =e'= CITY �� =11= L�✓ MA DATE �/ `� PERMIT ZZ— Z Z JOBSITE ADDRESS /3,/47/ C.( �7 �—� OWNER'S ME '/(-- r • '(_7 Ch i OWNER ADDRESS ` � - r TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7. FLOOR—, 9SM 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 ' DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY • ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET r.1 1 `i URINAL WASHING MACHINE CONNECTION I 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. YESB NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY 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. CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT `:l I hereby certify that all of the details and information I have submitted or entered regarding this application are tuie aQ accurate-A the best of my knowledge and that all plumbing wortyQnd installations performed under the permit issued for this application will be in co/np' rice with alertinent provision of the Massachusetts State PWmnbin Code andapter 142 of the General Laws. I/ ! // Cr- �"(-)2 ' PLUMBER'S NAME "(((jet LICENSE# /3 471'7'7 SIGNOURE MP,O JP❑ CORPORATION 0# PARTNERSHIP .# LLC❑# COMPANY NAME ,ir r" C'v/� -r. -e (-ic r L�� ADDRESS C LA"/G/ CITY S�T'ATE' ZIP GZ j U TEL `7,Cl S FAX Ly 2C ci CELL `G+-1 EMAIL Uffr-- ✓ / t✓Z ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Roov' Z 35 - Z 5 3 Yes No 2 f Z ( z THIS APPLICATION SERVES AS THE PERMIT 0 0 Ilq - I3"7 Vt-p FEE: $ PERMIT# PLAN REVIEW NOTES