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Home My WebLink AboutBLDP-23-000048 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 117_E_ _ Y;,, CITY YARMOUTH MA DATE 7/5/22 PERMIT# BLDP-23-000048 t ;?� JOBSITE ADDRESS 216 ROUTE 28 OWNER'S NAME SWAMI SHREE LLC P OWNER ADDRESS 216 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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 El 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 Anthony Coughlan LICENSE 16965 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANTHONY D COUGHLAN ADDRESS 469 LINCOLN ST CITY FRANKLIN STATE MA ZIP 020384271 TEL FAX CELL EMAIL tony@alphamanagementcorp.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK n , CITY_ MA DATE - PERMIT# • Z-S - oU cl Y • . t AC IA"; y hd /ice men! �t'P• JOBSITE ADDRESS Zt. rt4 i vi S�+ �J�S+ Yu-CM CL.tE11 OWNERS NAME)(p P OWNER ADDRESS 12.‘1 CI ti Cec(.1• S- SL2.:' l I TEL61-1-730r5IS8 FAXC�t /-230-Sd'8 it,-1 1.ak x ivtk , r i iv02 L(K 6 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL 0 PRINT PLANS SUBMITTED: YES 11 NO❑ CLEARLY NEW: RENOVATION:❑ REPLACEMENT: FIXTURES 7 FLOOR-6 BSM 1 2 3 4 5 6 _ 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ _ DEDICATED SPECIAL WASTE SYSTEM _ . DEDICATED GASIOILISAND SYSTEM — DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM 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 ALL TYPES WATER PIPING Jtt OTHER 4 l- C- . F -"CC V g1 t/ f ;4--6 y ✓T t, - . 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 ti 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 icompliance with Pertinent ' n ot1Ke Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME A nth O vuf C U ct...r LICENSE# 059 6 5- RE MP JP 0 CORPORATION Elf# PARTNERSHIP[}# LLC❑# COMPANY NAME�� A hc( lArayt�Q,yr.e.41'1- • ADDRESS 1249 jQ0.C,OLt S-c-f Scs� CITY YOr )a A/L STATE NI i- ZIP 02 `� ! vI'7 l TEL 17 ---7 015(?ScP I FAX �\-I-7 7 0' 7 ° .7 CELL 6'17- 7 q 1 1 Z,U EMAIL 4°n y `(-�t 11 q n?4Y/a 4]2fn er'1-E ci-wf.ecril