HomeMy WebLinkAboutBLDP-22-003304 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
..—� CITY YARMOUTH MA DATE 12/10/21 PERMIT# BLDP-22-003304
Il JOBSITE ADDRESS 657 ROUTE 28 OWNERS NAME MITROKOSTAS NAFSIKA E TR
P OWNER ADDRESS S8N REALTY TRUST PO BOX 260 SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0
PRINT
CLEARLY • NEW 0 RENOVATION:0 REPLACEMENTS,0 PLANS SUBMITTED: YES NO
FIXTURES 1 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
ROOF DRAIN _
SHOWER STALL
SERVICE/MOP SINK _
TOILET _
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 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 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 El 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 We 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 Joshua Carlino LICENSE 30034 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME (Awesome Guys Plumbing ADDRESS 72 Grove St
CITY Hyannis I STATE MA ZIP 102601 TEL 5082375369
FAX CELL 5082375369 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
nr
FEES$ PERMIT#
PLAN REVIEW NOTES