The URL can be used to link to this page

Home My WebLink AboutBLDP-22-003210 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � CITY YARMOUTH MA DATE 1216/21 PERMIT# BLDP-22-003210 t JOBSITE ADDRESS 35 OAK GLEN VILLAGE OWNER'S NAME ROBERTS DANIEL T P OWNER ADDRESS CRAIG CYNTHIA M 35 OAK GLEN VILLAGE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURFS FLOORS-. RSM 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 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 D 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 Adam Hufnagel LICENSE Y5256 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑6 LLC ❑6 COMPANY NAME ADAM HUFNAGEL PLUMBING 8 ADDRESS 167 Carriage LN CITY Barnstable STA1E IMA ZIP 02630 TEL FAX CELL 5083177409 EMAIL thehuff483@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ID FEES$ PERMIT# PLAN REVIEW NOTES • . , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •__=air— 4 CITY 1tk- i0' VV� =]_i=a` MA DATE Z PERMIT# ZZ" 32(U JOBSITE ADDRESS '3 S 6 c-t k L \tf'\. OWNER'S NAME 174 r.) /2066`'1-FS POWNER ADDRESS `Sai',14 - TEL " 5 '1-.3s 1 — ;FAX 3 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL L`J PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7. FLOOR—, 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM , ' DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I ' DISHWASHER • DRINKING FOUNTAIN ' FOOD DISPOSER I FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK ' LAVATORY I ROOF DRAIN SHOWER STALL , fi E C E I V E D • SERVICE 1 MOP SINK TOILET / ,I ' KC0 6 2021 p URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ey WATER PIPING ay t— — OTHER . INSURANCE COVERAGE: 1 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 THETYP,E-OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW [' 'UABILITY INSURANCE POUCY ' 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 l' Massachusetts General Laws, and that my signature on this permit application waives this requirement. SIGNATURE• OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ l I hereby certify that all of the details and information I have submitted or entered regarding this application are true d accura o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com n wit Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _— PLUMBER'S NAME LICENSE# SI ) SZ c t, SIGNATURE (� MP�] JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC V 3 7 b `(- r COMPANY NAME !'Moil il-,)r-oks-e ) ( .- 'J ADDRESS f b 7 (4 ry( `t' t' L v\ CITY �`•• '~ 5 19`P STATE 0 it ZIP OZ 6 , TEL O d 7 I YUl C�rwc 17 "Ike y[J�/-L{ (' �>;,c'rcc:S 1. Al /- FAX CELL EMAIL G 1 �� / C, 4=1132 - —7o — ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES •