HomeMy WebLinkAboutBLDP-22-004102 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _
u CITY YARMOUTH MA DATE 1/25/22 PERMIT# BLDP-22-004102
f( - JOBSITE ADDRESS 28 PROSPECT AVE OWNER'S NAME Joe Mangiaratti
D OWNER ADDRESS 128 PROSPECT AVE WEST YARMOUTH,MA 02673 TEL ]
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑
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 2 _
ROOF DRAIN _
SHOWER STALL 1 _
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 El NO E]
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 Jan Kvietok LICENSE 18892 SIGNATURE
MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME TATRA BUILDING CO.INC. ADDRESS 755 Rte 28 Suite H
CITY West Dennis STATE Ma ZIP 02670 TEL
FAX CELL EMAIL info@tatraco.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE 0 ❑
FEESS PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-wo 9 CITY Yarmouth MA DATE 1/24/2022 PERMIT# • Z
%1— `.(°
JOBSITE ADDRESS 28 Prospect Ave OWNER'S NAME Joe Mangiaratti
POWNER ADDRESS 28 Prospect Ave TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL IE
PRINT
CLEARLY NEW:❑ RENOVATION:® REPLACEMENT:D PLANS SUBMITTED: YES® NO❑ I
FIXTURES Z FLOOR-+ 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 SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER .
FLOOR 1 AREA DRAIN
INTERCEPTOR(INTERIOR) ,
KITCHEN SINK
LAVATORY 2
I ROOF DRAIN
,I SHOWER STALL 1
SERVICE/MOP SINK
-
TOILET 1 _ _
URINAL 1744._ "---WASHING MACHINE CONNECTIONs BD
WATER HEATER ALL TYPESf . Nk__, I.,-,-,,',R,1 il4t r7,,
WATER PIPING _ I 4 2022
OTHER f 1 r I
`lun
r
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO D
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
+ UABILITY INSURANCE POLICY ® OTHER TYPE OF INDEMNITY ❑ BOND 0
OWNER'S INSURANCE WAIVER:lam 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 0
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 Jan Kvietok LICENSE# U SIGNATURE
MP® JP F CORPORATION®#3607 PARTNERSHIP❑# LLC 0#
COMPANY NAME Tatra Building Company Inc ADDRESS 1268 Route 28
CITY South Yarmouth STATE MA Zip 02664 TEL 508-619-6073 '
FAX CELL 774-317-0593 EMAIL office@tatraco.com
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