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HomeMy WebLinkAboutBLDP-21-005302 BLD.2 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/16/21 PERMIT# BLDP-21-005302 Ii JOBSITE ADDRESS 497 ROUTE 28 OWNER'S NAME GRIFF HOLDING CORP P OWNER ADDRESS 497 MAIN ST WEST YARMOUTH,MA 02673 tl L. TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YESE NO El FIXTURES FLOORS—. BSM, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 8 10 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 10 11 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 3 INTERCEPTOR(INTERIOR) 1 KITCHEN SINK 10 11 LAVATORY 11 11 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK 1 TOILET 11 11 URINAL WASHING MACHINE CONNECTION 2 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 ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY El 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 Michael Gray LICENSE 12426 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP El# LLC El# COMPANY NAME Gray Boys Inc. ADDRESS 28 Nashua Rd Unit C CITY Billerica STATE MA 1 ZIP 01862 TEL 7812751233 FAX CELL 7815893627 EMAIL 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