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Home My WebLink AboutBLDP-22-003680 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/3/22 PERMIT# BLDP-22-003680 JOBSITE ADDRESS 105 BEACON ST OWNER'S NAME Joanne Sintiris P OWNER ADDRESS 105 BEACON ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO FIXTIIRFS 1 FLOORS-. RAM 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK 1 TOILET 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 0 NO 0 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 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 Chris Poire LICENSE 38901 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 37 Calvin Drive CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber@gmail.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -i=., CITY S �` ` `I `� Mb L� 8 MA DATE • PERMIT# • Z1--�(o'iL ,A _ � JOBSITE ADDRESS OS- C&'VC--DfJ Sf S' `l AOWVNER'S NAME Jt SAilW_S _ POWNER ADDRESS IOS— TELL I 7-3 20 - 4°9Z FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL.® PRINT, CLEARLY NEW:❑ RENOVATION: :1 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES 1 FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ . DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS101USAND 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 I/ ROOF DRAIN _ _ SHOWER STALL I 1' (- SERVICE(MOP SINK ly Hi _ . TOILET URINAL WASHING MACHINE CONNECTION J SO 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 N0 E IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY El BOND ❑ OWNE ' INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mas c se General Laws,and that my signature on this permit p' iea-waives tl>-s requirement. / CHECK ONE ONLY: OWNER ❑ AGENT Er- SIGNATU OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered reg arding 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 co pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. --------- PLUMBER'S NAME LICENSE# K.1.3 40'1.j SIGNATURE MP❑ JP Z CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME t,per FL 5 14eakS. fer(byADDRESS 3) LW,.ti O'- 4 CITY )c i 3 STATE01 ct ZIP O get I TEL 7-7tI P 34 Ctig FAX CELL 77J83io C, (6,I EMAIL