The URL can be used to link to this page

Home My WebLink AboutBLDP-23-000699 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK vF"1 CITY YARMOUTH MA DATE 8/11/22 PERMITS BLDP-23-000699 .74 JOBSITE ADDRESS 3203 HEATHERWOOD OWNER'S NAME Lori Pinard P• OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL CI RESIDENTIAL ❑d 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 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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❑ 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❑ 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 Paul Gorgone LICENSE 30873 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑X Lc ❑# COMPANY NAME PAUL R GORGONE ADDRESS PO BOX 1566 11 FROG TREE LANE CITY EAST DENNIS STATE MA ZIP 026411566 TEL FAX CELL EMAIL paulgorgone@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R E =j i yid vYlh„-44,_ MA DATE , r PERMIT# / AU G 1 0 2U4 2JO SITE ADDRESS tC) 1,,,-' •Qkuc ; Si �� .(<- OWNER'S NAME P\ v (1..csr-L A -3),e)-• EA ADDRESS TEL FAX BU LUIN _ EPAR—MENT av —a ' OR---BCCUP'ANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMI I I ED: YES ❑ NO❑ FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB t` ' 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I DISHWASHER • DRINKING FOUNTAIN i FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY i • ROOF DRAIN , , SHOWER STALL SERVICE I MOP SINK _ TOILET -4 I - i URINAL WASHING MACHINE CONNECTION 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. YES.i( NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY 21----. OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANC AIVER:I an aware that the licensee does not have the insurance coverage required by Chapter 142 of the t Massachusetts Ge ra aws, Ltd that m ignature on this permit application waives this requirement. / CHECK ONE ONLY: OWNER ❑ AGENT ❑ SI ATURE OF OWNER OR AGENT -\-1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true ands curate to the t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compti 'th all P provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � - PLUMBER'S NAME LICENSE#X 73 SIGNATURE MP❑ JP lg' CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME �—c vC1O(1C- ? -- H- ADDRESS F -F/l�- 0- CITY D a/2 4( STATE 41 ZIP 02_�,3 > TEL /f f •5 c/c7 f --G ' �nQ l Cr- G�2r-L, FAX CELL�6.T�4�_ EMAIL 7+AaJ� / (201 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT it PLAN REVIEW NOTES •