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HomeMy WebLinkAboutBLDP-22-005080 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/14/22 PERMIT# BLDP-22-005080 JOBSITE ADDRESS 9 BURCH RD OWNER'S NAME Dean Carpenito P OWNER ADDRESS 19 BURCH RD SOUTH YARMOUTH,MA 02664 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 CROSS CONNECTION DEVICE 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 7 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 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❑ 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 at 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 at 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 Joselin Sanchez LICENSE 31804 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# I PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSELIN C SANCHEZ ADDRESS 108 BAYVIEW ST CITY WEST YARMOUTH STATE MA ZIP 026738211 TEL FAX CELL EMAIL giovannisanchez524@yahoo.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 Cf"*"._0 ,--6, f(. � � CITY south yarmouth MA DATE 3-11-22 PERMIT # JOBSITE ADDRESS 9 Burch Rd OWNER'S NAME Dean Carpenito POWNER ADDRESS same as the above TELL FAX[ TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: v RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES E, NO, FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ,__it.,_. 11;.� F; CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 7-- -11 _ DEDICATED GAS/OIL/SAND SYSTEM * IIM DEDICATED GREASE SYSTEM1 f___ DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM R .1 ' .. I ' E P L DISHWASHER -.,. E. DRINKING FOUNTAIN FOOD DISPOSER - it + A I 4 = . -• i _ 1 FLOOR / AREA DRAIN r INTERCEPTOR (INTERIOR) - - t11iDN °DEP• _I I-MEIT - KITCHEN SINK ME - LAVATORY J 1 i w - ROOF DRAIN __~-- SHOWER STALL _ j 1 ,_____ SERVICE / MOP SINK _._ ___I TOILET 1 URINAL Il —IL.. . WASHING MACHINE CONNECTION 1 S,- WATER HEATER ALL TYPES -1` sir- --. 1 A WATER PIPING OTHER ,r` z ` -- -�.- `I 1 IL LL. , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ej NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v 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 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 i complia(ce with all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' vJ, 3V PLUMBER'S NAME Joselin C Sanchez LICENSE # 31804 �J h ATURE MP JP v CORPORATION # PARTNERSHIP❑# LLCE# COMPANY NAME Giovanni plumbing ADDRESS N/A CITY West Yarmouth STATE Ma ZIP 02673 TEL 508-360-1389 FAX I CELL 508-360-1389 EMAIL plumbing657@gmail.com 5tc/CVAFL 1K'