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Home My WebLink AboutBLDP-23-000196 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yr, CITY 'YARMOUTH I MA DATE 7/12/22 PERMIT# BLDP-23-000196 r.> JOBSITE ADDRESS 226 ROUTE 28 OWNERS NAME SIA DEVANG LLC P OWNER ADDRESS 226 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW: RENOVATION.❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO FIXTURFS • 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 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❑ 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 codify 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 Anthony Coughlan LICENSE 16965 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANTHONY D COUGHLAN ADDRESS 469 LINCOLN ST CITY FRANKLIN STATE MA ZIP 020384271 1 TEL FAX CELL EMAIL Itony@alphamanagementcorp.com 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 ti PERMIT# ,4,__. `•' CITY MA DATE • . t� S� �� + a Oat- ha �v, ,yrrien4 � . JOBSITE ADDRESS 22� r l Q l� � $ t t 'Yl� OWNERS NAME� p POWNER ADDRESS i2 1 el ` LCLc L.'Si-? SLF-i4,,, I, TELir-73D-;W FAX6P-730-5883 TYPE OR OCCUPANCY TYPE COMMERCIAL] EDUCATIONAL L. RESIDENTIAL[lj PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES E NO❑ FIXTURES Z FLOOR-f BSM 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 : I I DEDICATED GREASE SYSTEM _ _ DEDICATED GRAY WATER SYSTEM - - - DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER DRINKING FOUNTAIN 1 1 FOOD D:SPCSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) - KITCHEN SINK I LAVATORY • ROOF DRAIN _ SHOWER STALL _ SERVICE t MOP SINK _ TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING I- 140V Wr 1EcL r, ct t2--DAOrT Liy^r; _ ))L �'I (' OTHER' T ,� L 17 f c- %r) .-- t[- l y 'IA-L . 1 l v'� -1 INSURANCE COVERAGE: I have a current riabioty insurance policy or its substantial equivalent which meets the requirements of IVGL Ch.142. YESV6 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY pQ 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 Io1ovAedge and that all plumbing work and installations performed under The permit issued for this application will be in compliance with a, Pertinent n oLl1 e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -Ah}11 o✓w CoU- °Li LICENSE# l59 6 5- RE MP NI JP❑ CORPORATION Dr* PARTNERSHIP 0# :LC❑# COMPANY NAME Alpha M cut TyrR4't-4- Gyry• ADDRESS 1 z4at jQ - °-' S- sc2-1-e CITY /Q k `cam STATE Mit- ZIP 7.2.1"!(' TEL 17 -7 O I5J8 FAX (\ Il1 79)%' 6E33 CELL 17- 791`I`( L2-(0 EMAIL`3 t)7 GG g 1 ph�tm�na .�r-le-r1-1- e•ie 1 r