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Home My WebLink AboutBLDP-21-005728 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ykt - CITY YARMOUTH MA DATE 4/5/21 PERMIT# BLDP-21-005728 11�— JOBSITE ADDRESS 21 MONROE LN OWNER'S NAME MOSCA LAELZIO FERNANDO P OWNER ADDRESS 193 CAMP ST C-1 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 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 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 Marc Zade LICENSE#1146 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARC ZADE ADDRESS 57 MARGERY RD CITY BROCKTON STATE MA ZIP 023012846 TEL FAX CELL EMAIL marczade@hotmail.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 F l ^ .tt..:t. fileTt, CITY YARMOUTH 1 MA DATE 1/19/2021 g PERMIT# 4� P 1 - z I - p0 c 1 z JOBSITE ADDRESS 21 MONROE LN OWNER'S NAME STEVE & LENA PETLUCK pOWNER ADDRESS ,SAME i TEL 617-922-3133 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL '_ PRINT CLEARLY NEW: ] RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO 12 FIXTURES Z FLOOR--) BSM 4 6 8 9 10 11 BATHTUB `_ CROSS CONNECTION DEVICE ,1111111 DEDICATED SPECIAL WASTE SYSTEM MO 11 �._ _, `MI ._ , DEDICATED GAS/OIUSAND SYSTEMirpoilimactolown. _DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM r _ '_ . 111Misigialuils.1-- s� -, ,DEDICATED WATER RECYCLE SYSTEM f IlillamillismilifiliiiiiiiMiumMilliMinillirnias - DRINKING FOUNTAIN _ i . FOOD DISPOSER - ` FLOOR/AREA DRAIN1.11111.1.1111MaitamiemilliiiiMillitilliMilantimamtuni INTERCEPTOR INTERIOR) KITCHEN SINK INIIININI M_ MN tr _IIIMIR1M1111110W.1tI �lIlI LAVATORY � � ROOF DRAIN NNW an SSHOWER STALL M.-�NNW 1M 1N SERVICE/ MOP SINK MO_ irniiilialli um= 41101111111111.111111111° TOILET 1111017 1111111111111111111111. int UN INN___ URINAL T.MMINIMINIPM1111:111MAIIRMI_ KO E WASHING MACHINE CONNECTION ilimminggiongm - -. -� �_r_ -simumammi WATER HEATER ALL TYPES _ UN WO � : . 11 WATER PIPING �� 1MMJ OTHER Man' Mom am mum um imp 1.0 moi INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 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 1 Massachisetts General. • Ind nd th�t my signature on this permit application waives this requirement c:) / 1/A/------- - • - CHECK ONE ONLY: OWNER f AGENT I_ . SIG URE OF OWNER OR AGENT i hereby certify that all of the details and information I have submitted or entered regarding this application are and accurate to 1 : • • t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in nce with�.Pert'' - t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MARC ZADE : LICENSE # M-1,1146 �, - ` " GNATURE MP - JP CORPORATION I# PARTNERSHIP;,#1 1 Iu.cLJ#L COMPANY NAME ADDRESS 1 57 MARGERY RD CITY IBROCKTON STATE L itJ ZIP 02301 1 TEL FAX 1 CELL 508484.3737 I EMAIL ,marczadee hotmail.com