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Home My WebLink AboutBLDP-23-004245 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e CITY YARMOUTH MA DATE 1/31/23 PERMIT# BLDP-23-004245 err JOBSITE ADDRESS 37 LONGFELLOW DR OWNERS NAME MOYNIHAN GIOVANNA A TRS P OWNER ADDRESS PELLEGRINI JOSEPH TRS 82 BOUTELLE ST LEOMINSTER,MA 01483 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 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 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 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 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 0 NO 0 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 Virgilio Silva LICENSE 3N395 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga@holmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 01,C. a f I•} j .2 3 C l S Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES l/ 0 4 " CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i .z. 01/31/23 10:ZVI; . � CITY�'arm aa ,uth ort MA DATE � PERMIT # Z3 �- `-�IL `�! d�37 Lon fellow Dr.N J0� ADDRESS g OWNER'S NAME p 4A/ ING C �, g� 37 Longfellow Dr. 114g RESS g TELL.,.._ , FAX i LL, ______, TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL 1 PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: , PLANS SUBMITTED: YES [ NO❑ FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB r_- _ -,, . , _. ____. CROSS CONNECTION DEVICEIL, _ ' [- DEDICATED SPECIAL WASTE SYSTEM ' 7-1r r DEDICATED GAS/OIUSAND SYSTEM r- __ DEDICATED GREASE SYSTEM - NM an _ _. _ DEDICATED GRAY WATER SYSTEM . , �� DEDICATED WATER RECYCLE SYSTEM . DISHWASHER 1 . _ , . ; .. DRINKING FOUNTAIN - ,�— i - FOOD DISPOSER I y` FLOOR / AREA DRAIN ; i . .�. INTERCEPTOR (INTERIOR) I --ia- ,___ -. Fe______f =-. .4 KITCHEN SINK 1 LAVATORY 2 .--a:., - . . �.— ROOF DRAIN _ _ SHOWER STALL 1 ^_ SERVICE / MOP SINK —__ . TOILET 2 ! ___.u.:L_________=L., i I URINAL __,...�, . -1!---1r" ._..SF-WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 7,_ i( WATER PIPING OTHER � � _� �. ---0---- ____ _____________, ____________________. ..:_______r:77 011111111111111111 L.....r ,.. ....11___ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES jJ NO ❑ 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 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 in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Vircilio Silva LICENSE # 31395-J SIGNATURE MP 0 JP v CORPORATION #i _ PARTNERSHIP # ILLCLflL....... . .. . . . . . COMPANY NAME St ilva Plumbing & Heating ADDRESS 1155 Sudbury Lane CITYEyannis STATE MA ZIP r601 TEL I FAX CELL r74-836-°176 EMAIL Wrgiliomga@hotmail.com