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Home My WebLink AboutBLDP-22-005435 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �-/ CITY YARMOUTH MA DATE 3/29/22 PERMIT# BLDP-22-005435 1,- JOBSITE ADDRESS 72 STUDLEY RD OWNER'S NAME MILLER JEFFREY D P OWNER ADDRESS MILLER CAROLYN E 72 STUDLEY RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS • FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12_a 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY❑ BOND❑ OWNERS 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 Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Eugene Vobsevich LICENSE 20144 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME EUGENE VOLOSEVICH ADDRESS 486 Forest Rd CITY West Yarmouth STATE MA ZIP 026732843 TEL FAX CELL EMAIL VOLLOGG@MSN.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 _ , 4 0 �v , ,, $ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK lit=_-11-1:7' CITY/TOWN Y RU _u %/'lMA DATEPERMIT # .. � 0''2 8 N s� ti v L /e� OWNER'S NAME 4 �� ' /J��i'L ITE DRESS / Cry Y `� BUIL DEP�r0 R�4D ESS 7 �_ � �Gl p� f`Z TEL FAX FAX TYPE OR OCCUPANCY TYPE COMMERCIAL — EDUCATIONAL RESIDENTIAL - PRINT _ CLEARLY NEW: RENOVATION: 11 REPLACEMENT: PLANS SUBMITTED: YES NO ❑ 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 ---r — , DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) 1 KITCHEN SINK I I _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING P 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 TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY (1 BOND C OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachuse s - eral Laws, and that ignature on this permit application waives this requirement. iIr �I i� �� CHECK ONE ONLY: �OWNS AGENT n ' / GNATURE OF OWNER OR AGENT I hereby certify t .t all of the details and information I have submitted or entered regarding this application are true and accurate to the of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia ith all Perlin ion he Massachusetts State Plumbing Code and Chapter 142 of the General Lays. 1 kC PLUMBER'S NAME ��G��F�d `moo ! S 6 . ( LICENSE # a3 / gy SIGNAT E MP Li JP 0 CORPORATION # PARTNERSHIP U # LLC ❑ # COMPANY NAME Vd L a (j° `t" l ADDRESS 4-4 f" D o'Z-tyi $ 'r R ID CITY \lh o /77", STATE ZIP U A 4 7 TEL FAX CELL 6 / 7 -- ,� ?; f6�' EMAIL l/ aIndGG ni c ef GT• - 1 eeeP