HomeMy WebLinkAboutBLDP-22-004656 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
yp CITY YARMOUTH MA DATE 2/23/22 PERMIT# BLDP-22-004656
r n JOBSITE ADDRESS 173 NEPTUNE LN OWNERS NAME Timothy Welcome
P OWNER ADDRESS SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 1
ROOF DRAIN
SHOWER STALL 1 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 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 0
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 Charles Delvecchio LICENSE 18269 SIGNATURE
MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ICHARLES M DELVECCHIO ADDRESS PO BOX 719
CITY FORESTDALE STATE MA ZIP 026440702 TEL
FAX CELL EMAIL none
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE El El
FEES$ PERMIT#
PLAN REVIEW NOTES
04-0
- APPLICATION
)'ASS.2.:.'.:�_. ... �,1.:::R111 L...I .. ::. .A PER)II. 'R.'S R1111 R3 UME:N J WORK
r.
J ! MA DATE;2-22-22 i PERMIT 4 Z1-- `(4'5-6
FR '
�' IV 1 JOBSITEADDRESS i 1-3 I\l� LN• 1 OWNER'S NAME
1 [ i p 2 N i NEF1 A RESS 11-;3 ,Vi. hi - Lit + TEL) 1FAX
B u l T-YPEc h F 1-00g4N Y TYPE COMM RCIAL❑ EDUCATIONAL '.❑ RESIDENTIAL
By
CLEARLY RENOVATION: ' REPLACEMENT:❑ PLANS SUBMITTED: YES NO-0
i
FIXTURES Z FLOOR BSM 1 I 2 i 3 I 4 j 5 6 ' 7 I 8 9 10 11 i 12 i 13 j 14
BATHTUB I I
DROSS CONNECTION DEVICE I '
DEDICATED SPECIAL WASTE SYSTEM I I I ! ,
)EDICATED GAS/OIUSAND SYSTEM - j !
)EDICATED GREASE SYSTEM 1 I j I
)EDICATED GRAY WATER SYSTEM , ! I 11 i
)EDICATED WATER RECYCLE SYSTEM ! ' '
)ISHWASHER _ I j I
!RINKING FOUNTAIN It - T
000 DISPOSER i 1 l i
LOOR/AREA DRAIN I i ; • ( i I
ITERCEPTOR(INTERIOR) I I I I 1
ITCHEN SINK I ( I I I
\VATORY I ( ' 1 _ ( I
OOF DRAIN I j I
SOWER STALL j I 1 • - ( I_ _ 1
ERVICE/MOP SINK I + I
)ILET i1_ i I
2INAL • _ F
kSHING MACHINE CONNECTION 1 " I _
\TER HEATER ALL TYPES { r i 1 j
\TER PIPINGI 1
-HER i 1 T I 1 i
I 1 I I ! I 1
I I I
! 1 I1 (
INSURANCE COVERAGE:
we a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑
•OU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF.NDEMNITY ❑ BOND ❑
NER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
;sachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY. OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
eby certify that all of the details and information,nave suomitted or en:e-ed regarding this application are true/4nd r ' to the best of my knowledge
that all plumbing work and installations performed under the permit issues'or this application will be in corn Tans th Pertinent provi i n e
3echusetts State Plumbing Code and C ter ti of:he General Laws.
b1BER'S NAME[C,--( 1\-0 r k`le r._,ING i LICENSE#1 i l.3 M ' SIGNATURE
VJ°❑ CORPORATION❑# JPARTNERSHIPEk LLC❑#I ( II(
I I
PANY NAME; Gt9'?& 0+ H' ADDRESS i pp j)( -7c,c-' 1'
i--?1,f' STATE 1771 h� ZIP ( �7 .11 I TEL SCer L ?- (L 2 I
CELL 1996-�Z"Z l EMAIL j I I
S APPLICATION SERVES AS THE PERMIT YES NO FEE:$