HomeMy WebLinkAboutBLDP-22-006610 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 5/17/22 PERMIT# BLDP-22-006610
JOBSITE ADDRESS 191 STATION AVE OWNER'S NAME Dakota Refuse
P OWNER ADDRESS 191 STATION AVE SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES NO El
FIXTURES • FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE 1
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
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 El OTHER TYPE OF INDEMNITY El BOND El
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 (Mark Moran LICENSE 20786 SIGNATURE
MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME MARK R MORAN ADDRESS 16 BRAMBLE BUSH DR
CITY IFORESTDALE I STATE IMA ZIP 1026441017 TEL
FAX I I CELL I I EMAIL moranpandh@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE CI El
FEES S PERMIT#
PLAN REVIEW NOTES
- R
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
�- CITY SOUTH YARMOUTH j MA DATE l 5/11/22 PERMIT# fO O
JOBSITE ADDRESS ' 191 STATION AVE NAME! _ OTA- RAF--USE
OWNER'S DAK
OWNER ADDRESS 191 STATION AVE i TEL 508-685-0937 ,FAX III
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL >,._„ RESIDENTIAL I✓
PRINT CLEARLY NEW: 'V RENOVATION: REPLACEMENT: _PLANS SUBMITTED: YES ` NO1 i
FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _ a,._.._ . 1
F a'
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM ; _.._ _ ; _._._ __
DEDICATED GAS/OIUSAND SYS
TEM I 1' 'i /
DEDICATED GREASE SYSTEM i _' -, ^ , Y ' : . II 1
DEDICATED GRAY ,HATER SYSTEM 7' ) .. ..}
DEDICATED WATER RECYCLE SYSTEM �' -9, , _ 11 -� -
DISHWASHER ,_
DRINKING FOUNTAIN • : n•
FOOD DISPOSER .____ , ______ r _.... ).: _ ' ..._.._ _ :_...... 1 s�..__ _a �..._
t
FLOOR/AREA DRAIN
INTERCEPTOR (INTERIOR) $'
KITCHEN SINK
LAVATORY �_
ROOF DRAIN _ .._:: . _.-__ . r r.� , . u.$
s; x 31
SHOWER STALL a _._._ �__.. w. ... m., _... _
r
SERVICE 1 MOP SINK i 1,' -
•
TOILET �..__ __i n-_
f .
URINAL r Y s --7 F:_:
WASHING MACHINE CONNECTION
WATER NEATER ALL TYPES ;
WATER PIPING 3'
_te_ ,, -. .::._9
OTHER SPRINKLER BACKFLOW.,:_.: 1 a
7
,
I' y,
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ' / 'I NO I-.
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY f 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.
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 true and 9urate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co Iianc ith all P inent provision of the
22 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 49%)
/;/-7 PLUMBER'S NAME MARK MORAN LICENSE # 20786 SIG ATUR
MP JP i CORPORATION 4 PARTNERSHIP # LLC #
COMPANY NAME MORAN PLUMBING & HEATING ADDRESS 16 BRAMBLEBUSH DRIVE
CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934
FAX CELL 508-648-2934 EMAIL MORANPANDH GMAIL.COM
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