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HomeMy WebLinkAboutBLDP-22-005198 • y. /'r977o/� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ! CITY YARMOUTH MA DATE 3/17/22 PERMIT# BLDP-22-005198 `4:717- JOBSITE ADDRESS 26 MARGARET JOSEPH RD OWNER'S NAME PATTON TRAVIS D _ J P OWNER ADDRESS 26 MARGARET JOSEPH RD YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATIONS.0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO 0 FIXTURFS • FLOORS-a 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 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❑ 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 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 Mark Couto LICENSE 56856 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK J COUTO ADDRESS 103 LAKE SHORE DR —� CITY BREWSTER STATE MA ZIP 026312429 TEL FAX CELL EMAIL Imarkjcouto@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES + MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 7;1 CITY ' ____ i MA DATE JJ - 1 �' PERMiT# Z , -k2.7._ .„ , L JOBSITE ADDRESS -1 Nt a*re•4- 3i cf OWNER'S NAME �r^J t, P ft it P OWNER ADDRESS _ TEL iFAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL ' EDUCATIONAL RESIDENTIAL e PRINT 1'--" CLEARLY NEW: . RENOVATION: REPLACEMENT: v' PLANS SUBMITTED: YES ` NO' FIXTURES Z 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 GASIOIVSAND SYSTEM - __ DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _L DISHWASHER _ DRINKING FOUNTAIN _-_ — __ _ _ FOOD DISPOSER FLOOR J AREA DRAIN INTERCEPTOR (INTERIOR) _ _ KITCHEN SINK LAVATORY ROOF DRAIN - SHOWER STALL _ 1 SERVICE / MOP SINK t ,F._C -F 1 V E- -._ -_ TOILET URINAL y.: _ ._ _WASHING MACHINE CONNECTION ,MAR. 17L WATER HEATER ALL TYPES C . - -- i WATER PIPING OTHER — - - - - t av r-- — ---- 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 f 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 I SIGNATURE OF OWNER OR AGENT ' I hereby certify that all of the details and information I have submitted or entered regarding this applicatiofi a? true and accurate to the best of my knowledge and that ail plumbing work and installations performed under the permit issued for this application will be in iance vyith all rtinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i/ �y� , PLUMBER'S NAME : Mark Couto LICENSE # 15856 SIGNATURE MP i JP' CORPORATION i #. 3408 PARTNERSHIP # LLC #- .. . I COMPANY NAME Mark Couto Plb & Htg inc_ ADDRESS 103 Lake Shore DrR ___ CITY' Brewster STATE MA . ZIP 02631 _ TEL 508-965-2145 rx n,-f-__i ._�_a..� �.��rs.,��.- -- FAX 508-896-2577 CELL EMAIL Markjcouto@yahoo.c�om