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Home My WebLink AboutBLDP-23-004747 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Cl ��iN % CITY YARMOUTH MA DATE 2/27/23 PERMIT# BLDP-23-004747 $tom. , JOBSITE ADDRESS 83 SISTERS CIR OWNER'S NAME William Dasilva u P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS-4 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1 KITCHEN SINK 1 1 LAVATORY 1 3 2 ROOF DRAIN SHOWER STALL 2 2 SERVICE/MOP SINK TOILET 1 2 2 URINAL WASHING MACHINE CONNECTION 1 _ WATER HEATER 1 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 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. 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 Andrew Hayes LICENSE 1;6489 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PLUMBING SOLUTION BY HAYES ADDRESS 22 Rustic Lane CITY Hyannis STATE IMA -I ZIP 02601 TEL FAX I I CELL 7747225013 —I EMAIL PLUMB_HAYES91@YAHOO.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES 1 ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .1_ e - 3 CITY r el&:; / / z, ,_i 7 r"t 7 F== MA DATE � ��/�� PERMIT# 'L 7 AD�RESS `6 3 J;5}c,, E.;. . l OWNER'S NAME�% 1\.c.n. �<� ,`�:. BU L G DEPiOWNERADDRESS 5 3 s•IQ,, L.,L. l,. TEL FAX ay _ _ PE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ❑ RESIDENTIAL❑— PRINT CLEARLY NEW:27 RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO Lr FIXTURES 1 FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM i DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM ' DEDICATED GRAY WATER SYSTEM I H DEDICATED WATER RECYCLE SYSTEM DISHWASHER , , DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN - 1 INTERCEPTOR(INTERIOR) t KITCHEN SINK 1 ' , LAVATORY f ' 3 J-- ROOF DRAIN SHOWER STALL _ . . SERVICE/MOP SINK TOILET t 4- • " URINAL 1 WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES ' , l ' WATER PIPING ' OTHER II INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q' NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY [/ OTHER TYPE OF INDEMNITY ❑ 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT �l I hereby certify that all of the details and information I have submit_ed 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 compli ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME iiklc'K- tEL L' LICENSE# /0/V1 . SIGNATURE MP E JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME i7I Om 5 1 S*:,lo4o^s R y 14qy/J,�.% ADDRESS -J Z bet:5 4; 1,cvw CITY () .) „), ; J STATE M1 ZIP C.2. L c; 1 TEL FAX CELL 1/4" 322 - 0/3 EMAIL f 1L)N5 Incyt1 11 0.1i...6ou canr ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES