Loading...
HomeMy WebLinkAboutBLDP-23-003779 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y r. CITY YARMOUTH MA DATE 1/11/23 PERMIT# BLDP-23-003779 r JOBSITE ADDRESS 50 ALMS HOUSE RD OWNER'S NAME Matt Ovane P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES l FLOORS-. RSM 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 1 SERVICE/MOP SINK TOILET 1 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 0 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❑ 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 Adam Hufnagel LICENSE 1E256 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADAM HUFNAGEL PLUMBING& ADDRESS 167 Carriage LN HFATlNC I I r CITY Bamstable STATE IMA I ZIP 02630 I TEL FAX CELL 5083177409 EMAIL thehuff483@comcast.net 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 __nip_ CITY C 1 M '' V� fi MA DATE ) ( 1 7 3 PERMIT# __)i_a q Cf� ��—% JOBSITE ADDRESS 0 A. 1 C Y'� t-ovs RC' OWNER'S NAME/Ilk r+1 JC"(C.�'i� V y� \(�)e► POWNER ADDRESS >GI('1- TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL- PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT:Prrr PLANS SUBMITTED: YES❑ NO❑ FIXTURES T FLOOR-+ BSIi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM II DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ■- DEDICATED GRAY WATER SYSTEM • / 11111 DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ■FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK �� LAVATORY j ROOF DRAIN SHOWER STALL I 1 SERVICE!MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER I i INSURANCE COVERAGE: 1 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESZ(NO E IF YOU CHECKED YES, PLEASE INDICATE TH tYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 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. ----_.1 CHECK ON ONLY: OWNER AGENT ❑ SIGNATURE OF OWNER OR AGENT `'J I hereby certify that all of the details and information I have submitted or entered regarding this application are tr.e and accur e to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co fiance yoit I P 1 ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A C// //�/7 PLUMBER'S NAME Pt k1(( t•---\ J c�LtC3 e,( LICENSE# J 5 Z�j j 666 SIGNATURE MP V JP ElCORPORATION # PARTNERSHIP❑.# LLC Di�7(C COMPANY NAME 6 C1CI�I'l /ty G r I C ek. = t. n !�� (� L ADDRESS I b7 t�G1 L 1 CITY i` L( V\ bl f STATE 1),II ZIP ,t] Z 3 0 TEL /FAX CELL SC-:`>-3( - /-77t' ! EMAIL ) he q1.,J �Ltc-6- m c-v-((ft51 0 rt o z � o i H U W z 01 o Z o a o 111 o o w C2 U LL d. C!) LLI W cn W H 0 H 0