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HomeMy WebLinkAboutBLDP-23-000139• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 7/11/22 PERMIT# BLDP-23-000139 t JOBSITE ADDRESS 226 ROUTE 28 OWNER'S NAME SIA DEVANG LLC P OWNER ADDRESS 226 ROUTE 28 WEST YARMOUTH,MA 02673 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO El 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/OIUSAND 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 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 El BOND El 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 8B965 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑ COMPANY NAME ANTHONY D COUGHLAN ADDRESS 469 LINCOLN ST CITY FRANKLIN STATE MA ZIP 020384271 TEL L 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 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES „.._©©' :� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK o? -,a- :1 V E D • PERMIT# • 2”3 i3 J t _ .Gc MA DATE .- U g ��51T ADDRESSZ.{ �b )4Q i vl 54t � St Ya-Ti-n O�.t.E41 OWNER'S NAME 1;4t�i r^a-S-to n4 g ` LeLC- S� S .�.,- . TEL -730. 5Sc`�C4 FAx 6("i-730-c6' OWt�! ADDRESS I2- , Tt t, BUILDI^' ' DEPARTMLNl 0-40c.f�V1k fl lA- 02Lo Vt 6 `- T'PE OR-- QCCUPANQY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL E PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:' PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-' BEM 1 2 3 4 5 6 7 6 9 10 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ . DEDICATED SPECIAL WASTE SYSTEM _ _ , DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM I - DEDICATED GRAY WATER SYSTEM J - . DEDICATED WATER RECYC:E SYSTEM - DISHWASHER 1 DRINKING FOUNTAIN ' FOOD DISPOSER - FLOOR l AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK , LAVATORY • ROOF DRAIN _ SHOWER STALL SERVICE/MOP SINK _ TOILET URINAL . WASHING MACHINE CONNECTION t I WATER HEA ER LL TYPES ! WATER PIPING ' ! OTHER 1- oo JAC )Tit_ V- I,}'F`4 t r r 1 1 Is. i !-V,/c r (,,'A Vkir INSURANCE COVERAGE: ``,.� I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGE Ch.142. YES O NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 4 OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCF 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 OW Y: 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 wit be in compliance with Pertinent ' n offfie Massachusetts State Plumbing Code and Chapter 142 at the General Laws. -� PLUMBER'S NAME -AY0-11 ovu{ Couq Ct VA LICENSE# \159 6 JJ MP W JP❑ CORPORATION '' '# PARTNERSHIP❑# LLC 0# COMPANY NAME tt115ii� �( � U VI L'YMeV l r rilf ADDRESS 1 L4 9 n c 4+ l S c, Si_o_14 Q CITY vU j617Lk-- STATE* NI ZIP O2"l 1 A TEL 7 7 3 0 • 6dSG)9 FAX kb 7r722G-- EE8g ' CELL ' I7-711 c.11—I ( 1) EMAC*OnyC-cklpl'1Cl Tr)et)7Qt. �fv1 '&14CLif'i , t `J