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Home My WebLink AboutBLDP-23-004784 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK n %' CITY YARMOUTH MA DATE 2/28/23 PERMIT# BLDP-23-004784 JOBSITE ADDRESS 18 AUTUMN DR OWNER'S NAME Diego Baveloni P OWNER ADDRESS 18 AUTUMN DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES I FLOORS BSM 1 , 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION 1 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY❑ BOND❑ 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. PLUMBER'S NAME BRADLEY TOMASETTI LICENSE 46544 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME TOMASETTI PLUMBING ADDRESS 103 UNION ST CITY YARMOUTH PORT STATE MA ZIP 02675 TEL FAX CELL EMAIL tomasettiplumbing@gmail.com t ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES S iatt _c -- HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ;_ <• CITY y'(-7 / .„..,.v - &7 MA DATE ) /Z 7 [ �' ++-- ^8 n �Z'G PERMIT# 7 `j JO�5 SS I 4-../--U,,,,eel /2,-- OWNER'S NAME '.2 eye' At".'rot` r3 INGU farEattittoSS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:' REPLACEMENT:❑ PLANS SUBMI I I ED: YES El NO❑ FIXTURES 7 FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I / CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM . DEDICATED GAS/OIL/SAND SYSTEM • , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM , DEDICATED WATER RECYCLE SYSTEM -, DISHWASHER j DRINKING FOUNTAIN FOOD DISPOSER ,FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK i LAVATORY k; - i ROOF DRAIN SHOWER STALL _ SERVICE/MOP SINK I TOILET I i , URINAL • WASHING MACHINE CONNECTION I - WATER HEATER ALL TYPES , WATER PIPING 1 _, OTHER — - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i UABIUTY INSURANCE POLICY 217. 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 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. T CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z SIGNATURE OF OWNER OR AGENT 'Lt I 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. lr PLUMBER'S NAME ''•=c ,e"`3 LICENSE#/(-iy . IGNATURE MP V� JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC El# COMPANY NAME J Se&", p/u�,b iAI c ADDRESS I C� i Lr' A, c rJ 5 i-- CITY fi ti,U,) ‘I-`l 7"7.,-- STATE/I/% ZIP CJ 7C, 7�` TEL FAX CELL 5-67-J cf Z Z -`iL'C'I EMAIL /Ow e; $ t 741-; /4,,.+1 4,-/- 6),,,,,,,,L /- y 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 1