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Home My WebLink AboutBLDP-23-000049 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH w,jMA DATE 7/5/22 PERMIT# BLDP-23-000049 r JOBSITE ADDRESS [26 ROUTE 28 OWNER'S NAME SIA DEVANG LLC P OWNER ADDRESS 226 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0 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 wit 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 LICENSEIi6965 SIGNATURE MP 0 JP 0 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$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK T. v ./ -7-.1) - ooy 9 �— CITY MA DATE - PERMIT# . JOBSITE ADDRESS 122-‘ PICA 41 54, k'‘.1S+ Yafl71 ct`h OWNERS NAME A(pM AvActemert4 at`p. P OWNER ADDRESS 121i g 2CeCC ''S-�� STLe,a-e `` TEL6i/-730 556°8 FAX 1 /-730-Cg c �vtk , /1/I 02�tK 6 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENTS PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 FLOOR-4 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I 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 i 6A C. K 5 ' •O--C.M' 1p E v E Ai Tc OTHER , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESyA NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POLICY isi OTHER TYPE OF INDEMNITY 0 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. 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'n compliance wtth Pertinent ' n o(Jlte Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -A Y1-01 ov C4Ai a LICENSE# ‘59 6 g- •---------sr. RE MP 1 JP❑ CORPORATION EA PARTNERSHIP❑# LLC❑# COMPANY NAME Alpha M avi Try,.e4'r4- Gil? ADDRESS 1249 o c o ` S� 1- CITY Ya,/o o.ieLA4.er STATE' NI - ZIP Q2-4 L1A TEL (�'17 r7O • 15d Sd9 FAX 11 772j0- 5 R ' 3 CELL ' I7— 7 C R —1 I20 EMAIL`T"O nc y a ck I pAciMetria5�mP-rI+C,fx'e• 1 V