HomeMy WebLinkAboutBLDP-23-004396 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
cti �? CITY YARMOUTH —1 MA DATE 2/8/23 PERMIT# BLDP-23-004396
F" JOBSITE ADDRESS 52 PRINCE RD OWNER'S NAME Paul Cruz
P OWNER ADDRESS 52 PRINCE RD WEST YARMOUTH,MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESD NO❑
FIXTURES 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
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
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 D NO D
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 Andrew Hayes LICENSE 16489 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP D# LLC ❑#
COMPANY NAME PLUMBING SOLUTION BY HAYES ADDRESS 22 Rustic Lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX CELL 7747225013 EMAIL PLUMB_HAYES91@YAHOO.COM
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ 111
FEES$ PERMIT#
PLAN REVIEW NOTES
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I �, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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BU� DING DEYAITNA9RtSS 2 Pr i TEL c_.c TEL FAX
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TYFt UK UUUUPAfVCD1YPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW:Q"' RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI I I ED: YES ❑ NO 1-2,
FIXTURES - 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 1
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK '
LAVATORY I T -H
ROOF DRAIN + ,
SHOWER STALL
SERVICE/MOP SINK
TOILET f
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES f -
WATER PIPING
OTHER 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
UABIUTY INSURANCE POUCY 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
1 Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER IDAGENT II]
SIGNATURE OF OWNER OR AGENT
Vi 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 complian ' all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME As'►gir'r:-% I .5 LICENSE# 144 b'i . SIGNATURE
MP I2' JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑#
COMPANY NAME Ph)rih;'1a J Sate.. doS Ay t --� ADDRESS 2t i..i-i 'c Lo-0—
CITY 11 ��n'1 'i STATE Al IV ZIPLLc k TEL
FAX CELL314 - in -.i"C '3 EMAIL ei JAli".—Le.L-)q I Q=#.;1.c„ •L,c..-.
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