HomeMy WebLinkAboutBLDP-22-005206 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
rn' CITY YARMOUTH MA DATE 3/17/22 PERMIT# BLDP-22-005206
lu JOBSITE ADDRESS i66 SPRINGER LN OWNER'S NAME Frank Zappula
P OWNER ADDRESS TEL r
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL al
PRINT
CLEARLY NEW:0 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 1 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 2 2
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2 1
URINAL
WASHING MACHINE CONNECTION 1
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❑ 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 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 Troy Gilbert LICENSE 25383 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME TROY J GILBERT ADDRESS 39 STATION ST 39 STATION ST
CITY WAREHAM STATE MA ZIP 025711324 TEL
FAX CELL EMAIL Ikatherine@coastalphc.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
STA. - SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
iv t
-...►� CCTV—
rr�outh MA DATE 03/07/2022 PERMIT# • -2 2 f S 47I. ,.i‘wy.' �.
15 � D 166 Springer Lane West Yarmouth MA 02673 OWNER'S NAME Frank Zappula
B U I L 11G U E NicWiNaR ATDPESS 166 Springer Lane West Yarmouth MA 02673 TEL FAX
By -- - -
TYPE OR OCCUPANC TYPE COMMERCIAL ❑ EDUCATIONAL [l RESIDENTIAL iii
PRINT
CLEARLY NEW: [l RENOVATION: IV REPLACEMENT: PLANS SUBMITTED: YES ❑ NOV
-
FIXTURES Z FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 1' _
CROSS CONNECTION DEVICE _ ,
DEDICATED SPECIAL WASTE SYSTEM _
DEDICATED GAS/OIL/SAND 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 2 2 ,
ROOF DRAIN _ ,
SHOWER STALL 1
SERVICE / MOP SINK
TOILET 2 1
URINAL .
WASHING MACHINE CONNECTION . 1 _ _ .
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' 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: 1 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.
4/ 5,1 CHECK ONE ONLY: OWNER ' AGENT C
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. -28 G1�1��
PLUMBER'S NAME Troy J Gilbert LICENSE # 25383 GNATURE
MP ❑ JP' CORPORATION '#4350 PARTNERSHIP ❑ # LLC ❑ #
COMPANY NAME Coastal Mechanical ADDRESS 21 L Fruean Ave
CITY Yarmouth STATE MA ZIP 02673 TEL 508-737-8747
FAX CELL 508-850-6955 EMAIL Katherine@Coastalphc.com