The URL can be used to link to this page

Home My WebLink AboutBLDP-22-006149 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK M,{i CITY YARMOUTH MA DATE 4/26/22 PERMIT# BLDP-22-006149 JOBSITE ADDRESS 52 WILFIN RD OWNERS NAME Valentina Karcha P OWNER ADDRESS I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK — TOILET 2 1 URINAL WASHING MACHINE CONNECTION 1 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 0 NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND 0 OWNERS 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. PLUMBERS NAME Mircha Karcha LICENSE 16274 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MIRCHA KARCHA I ADDRESS 113 WESTVIEW LN CITY FEEDING HILLS STATE MA ZIP 010302258 TEL FAX CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • � �' �� Vag o� Z- L19 _+-'�;_ CITY T'1 ' MA DATE �/ �� ,L PERMIT# Z JOBSITE ADDRESS .., u91/ ,I C2 /'z®d OWNER'S NAME(/O- e1 77`1 et, Wwf'L ell P OWNER ADDRESS J13 Z�eji—t/IratJ /i e /— yT4 4.3, CI70FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[417— PRINT CLEARLY NEW:V 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/OIL/SAND SYSTEM J DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / LAVATORY I- ROOF DRAIN SHOWER STALL I SERVICE!MOP SINK R C t I d E ES TOILET X I `r URINAL APR d 6 21122 WASHING MACHINE CONNECTION / sI- . WATER HEATER ALL TYPES J , WATER PIPING I L btt�tG ' OTHER RY -�------�- - t 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ^/r LIABILITY INSURANCE POLICY �1�' 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT LI I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accuFate 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 LICENSE# SIGNATURE MP IDY JP❑ CORPORATION❑# PARTNERSHIP Q# LLC El# COMPANY NAME 1'69/2 C/�a �...0 /9/ ) hill, ADDRESS P5 ( e-friii 9 /4-)--)e_ CITY j" eel) h) /1;k5 STATE n ZIP 0(D3 OTEL FAX CELIL 03 l 3 yI 9��d EMAIL i - • • o • H U 1 Z i N z cc H 0 Cl- tt z U = c a w 0 • EnW a c 0 o cK a p a_ ¢ �r w z w U_ U) W f� 0 z 0 H U V) z 5 0