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Home My WebLink AboutBLDP-22-007051 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yhk:.} CITY YARMOUTH if JOBSITE ADDRESS 95 LEWIS RD MA DATE I6/6122 PERMIT# BLDP-22-007051 OWNER'S NAME TUCKE CATHERINE M TR P OWNER ADDRESS 20 MARIE AVENUE CENTERVILLE,MA 02632-3732 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 WATER HEATER WATER PIPING 1 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 E 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 BRADLEY TOMASETTI LICENSE 16544 SIGNATURE MP ❑ JP ❑ CORPORATION ❑o PARTNERSHIP ❑# LLC ❑# COMPANY NAME ITOMASETTI PLUMBING ADDRESS 103 UNION ST CITY YARMOUTH PORT STATE MA ZIP 102675 TEL FAX CELL � - "l Os-"' .' no EMAIL tomasettiplumbing@gmail.com 19 i-7 ROUGII PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes Na THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 3 CITY/a% I. t I,/r / MA DATE 4)/ /e 0 ? t- PERMIT# -47- -70 J JOBSITE ADDRESS �I > 1-("j t/i /`ck9 OWNER'S NAME 54C%I4 f POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El---- PRINT CLEARLY NEW:❑ RENOVATION:ti REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN E • E v .; 1 I INTERCEPTOR(INTERIOR) KITCHEN SINK 4 I. I I LAVATORY 2 • I J '. ROOF DRAIN SHOWER STALL ' DIN DE'ARTMENT SERVICE/MOP SINK — TOILET URINAL j WASHING MACHINE CONNECTION I _ _ i WATER HEATER ALL TYPES WATER PIPING i OTHER _ i I 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 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the i Massachusetts General Laws,and that my signature on this permit application waives this requirement. 1� CHECK ONE ONLY: OWNER ID AGENT ❑ Z SIGNATURE OF OWNER OR AGENT I 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 knowledgf 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 )j� �i�,l Ho f„,4 5e J,. LICENSE# /�5,i y . SIGNATURE MP p JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME I i orb ic S e I tl'' Fit'''.(-. t I-,` IA_ ADDRESS 103 (,(„, 4 5./- CITY y.,,-,tau A /c -t STATE f_I ti ZIP 0 Z. 6 `7 S— TEL 5'7.- 9 z Z- 1/o 0/ FAX CELL EMAIL Mr-, a s C /. . /41,- iyr?* C16, - 11 `5 /y0 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT [ J Li FEE: $ _ PERMIT # PLAN REVIEW NOTES