HomeMy WebLinkAboutBLDP-21-006829 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
t c CITY YARMOUTH MA DATE 5/24/21 PERMIT# BLDP-21-006829
‘1771JOBSITE ADDRESS 86 Old Hyannis Road,Yarmouth Port,MA OWNER'S NAME RUHAN GENERAL CONTRACTING,
02/
P OWNER ADDRESS gOLD HYANNIS ROAD YARMOUTH PORT,MA 02675 LLC TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑
FIXTURES - FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 _
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 1 3 1
ROOF DRAIN _
SHOWER STALL 1 1 _
SERVICE/MOP SINK _
TOILET 1 2 1 _
URINAL
WASHING MACHINE CONNECTION 1 _
WATER HEATER 1 _
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 E]
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 Daniel Messier LICENSE*640 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME DANIEL C MESSIER ADDRESS 237 ELM ST
CITY N ATTLEBORO STATE MA ZIP 027603223 TEL
FAX CELL EMAIL danmessierplumbing@yahoo.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE PERMIT ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
,37Z11475; CITY 7c�V"�(Y1
=1 OUP MA DATE • PERMIT#SLOP` 21-oO(c L9
JOBSITE ADDRESS 8G 01(1 1"-'\/& M 1/41S &. OWNER'S NAME
OWNER ADDRESS !! TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL$
PRINT
CLEARLY NEW:Z. RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ N
FIXTURES 7 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 GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER J
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK l
LAVATORY f �j 3
ROOF DRAIN
SHOWER STALL j
SERVICE I MOP SINK
TOILET 1 ` I
URINAL
WASHING MACHINE CONNECTION I
WATER HEATER ALL TYPES I
WATER PIPING
OTHER
INSURANCE COVERAGE:
i have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE . NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY 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.
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that ail 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 co �a(.ce wit all P 'n t provision of the
Massachusetts State Plumbing Codep and Chapter 142 of the General Laws. �
PLUMBERS NAME 1 55141- LICENSE# SIGNATURE
MP& JP❑ CORPORATION pt 360i, PARTNERSHIP❑# LLC❑#
COMPANY NAMES)AN AP,65ter P4 _T NL ADDRESS a 3 7 F.:/ph
s/
CITY kJ rf f-407) ' STATE/tM, 4 ZIP 6 O TEL 77 [ WO.
FAX CELL . 1 I1 V&Q_ EMAIL V +
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑
FEE: $ PERMIT #
PLAN REVIEW NOTES