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Home My WebLink AboutBLDP-21-002932 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/20/20 PERMIT# BLDP-21-002932 JOBSITE ADDRESS 17 LEGEND DR OWNER'S NAME LANE GERALD T P OWNER ADDRESS COSCO CAMILLE A 140 SOUTH STATE RD BRIARCLIFF MANOR,NY 10510 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES _r 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 El NO El 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 Charles Delvecchio LICENSE 1)3269 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Charles M Delvecchio ADDRESS PO BOX 719 CITY FORESTDALE STATE MA ZIP 026440702 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEESS PERMITS PLAN REVIEW NOTES APPLICATION # v +I i�aaCr�� 1:'�VJ"`iCKL 9 5 UNLJs.rrn�+ APPLICATION ^- C ilil FOR A FERMI TO PERFORM PLUMBING WORK I _, ____ 1 CITYrV w� I MA DATE ) 1' — �1 PERMIT# 6(LP--eii--apKi _____ . ,..,, JOBSITE ADDRESS L,c3 €j\i > 1-11 J . OWNER'S NAMEe_,f-cVJpjv i P OWNER ADDRESS I TEL � f jFAXJ I TYPE OR OCCUPANCY TYPE COMMERCIAL n EDUCATIONAL ❑ RESIDENTIAL Er PRINT CLEARLY NEW: RENOVATION: [ZI REPLACEMENT: ii," PLANS SUBMITTED: YE S NOL FIXTURES 7 FLOOR—► BSM 1 2 1 3 J 4 5 6 7 8 9 10 11 12 13 14 3ATHTUB CROSS CONNECTION DEVICE - - JEDICATED SPECIAL WASTE SYSTEM _ 1 )EDICATED GAS/OIL/SAND SYSTEM. _ _ _ . )EDICATED GREASE SYSTEM - _ )EDICATED GRAY WATER SYSTEM - - )EDICATED WATER RECYCLE SYSTEM ` )ISHWASHER - . C 'RINKING FOUNTAIN OOD DISPOSER LOOR!AREA DRAIN lTERCEPTOR (INTERIOR) - ITCHEN SINK ' ` ' \VATORY �:.____��...�.._ _. �__ _ -� DOF DRAIN - - _ y� :.._. �. `c. -TOWER STALL =RVICE I MOP SINK . i - ,^. , . -a , c; i )ILET _ h Vi1) E _ ¢ ,' a ZINAL - - , i 7 1 SHING MACHINE CONNECTION r l ,Li . ,t, t . ,, i; _ T \T ER HEATER ALL TYPES - \TER PIPING HER INSURANCE COVERAGE: we a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO 7 .OU CHECKED YES, PLEASE INDICATE THE.TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ NER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ;sachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY:/ ,-OWNER E AGENT eby certify that all of the details and information I have submitted or entered regarding this application are tru nd :� r.,� " to th e best of my knowledge that all plumbing work and installations performed under the permit issued for this application will be in compliant- ithi Pertinent provision ,Uie ;achusetts State Plumbing Code and CKer 142 of the General Laws. `, V1BER'S NAME (..._,649-.1r1D-)----. \ ✓k\1te ��` ' LICENSE (` � # I If I �I I SIGNATURE rei JP CORPORATION❑# PARTNERSHIP fI#J JLLCfl#j I PANY NAME! C ?b ? - '+ ADDRESS I R.) 3o < ---7c, i F4 -"D n - STATE r l' ( - Z1PLI TEL -_,..,--- - Li - CELL so lZ7 1 EMAIL C.)4r1 37o \9\66.. i 3 APPLICATION SERVES AS THE PERMIT YES NO FEE. $ C -)P