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Home My WebLink AboutBLDP-22-004923 #C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/7/22 PERMIT# BLDP-22-004923 JOBSITE ADDRESS 27 BRIAR CIR C OWNERS NAME 000NEY PETER P OWNER ADDRESS LUCAS CAROLE 27 BRIAR CIRCLE SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D PRINT CLEARLY NEW:❑ RENOVATION:D REPLACEMENT.0 PLANS SUBMITTED: YES NO❑ FIXTURES FIOORS—, 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 1 - DRINKING FOUNTAIN _ FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 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❑ 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. PLUMBERS NAME An Truong LICENSE 30771 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME AN H TRUONG ADDRESS 8 WORDSWORTH ST CITY RANDOLPH STATE MA ZIP 023682116 TEL FAX CELL EMAIL truongplumbing@idoud.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMIT# PLAN REVIEW NOTES - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .1= =s, /� Z 2 LI Z� {• R r'1'r-'� : �J ��0�'�/� MA DATE -. ^ a PERMIT# --L—__ 1 JOB ITE ADDRESS27467277 JG)o C(A.'/G1 C OWNER'S NAME MAI 3 2C2a 4DDRESS3gfC1 Vt I.l ' .l TELr7 r5? r(774 �l B1)IL LQJFRARTVU� CYTYPE COMMERCIAL EDUCATIONAL E3y _ _ ❑ ❑ RESIDENTIAL®� RINT — CLEARLY NEW:❑ RENOVATION:V REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES T FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 11:1 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 I DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK / LAVATORY ROOF DRAIN _ SHOWER STALL t SERVICE/MOP SINK TOILET 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 NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TY 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 t 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 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 ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J%C PLUMBER'S NAME A W / J4 6 N C� LICENSE#3 O7 7I SIGNATURE MP❑ JP V CORPORATION❑# PARTNERSHIP❑.# LLC❑# ,l! COMPANY NAME / ,u ,/ 7(� ) C 1" ADDRESS X Cavt.id 0 0-A ()j— ury f 14/AJ cI e )7 STATE ZIP C.) -j Ci ,T. TEL ( G t , qn FAX CELL EMAIL #2 / ✓V 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 1