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Home My WebLink AboutBLDP-21-004427 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k, t o CITY YARMOUTH MA DATE 2/4/21 PERMIT# BLDP-21-004427 *-1 ft JOBSITE ADDRESS 24 HASTING AVE OWNER'S NAME JACOVIDES GEORGE L TRS P OWNER ADDRESS JACOVIDES BETTY S TRS 5 WEST ST ARLINGTON,MA 02476-7135 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑v PRINT CLEARLY NEW: ❑ RENOVATION:E REPLACEMENT:❑ PLANS SUBMITTED: YES 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 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❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY El BOND El 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 Moran LICENSE 20786 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME MARK R MORAN ADDRESS 16 BRAMBLE BUSH DR CITY FORESTDALE STATE MA ZIP 026441017 J TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT El FEES$ PERMIT# PLAN REVIEW NOTES '� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK j�q� /t / " _—4 CITY WEST YARMOUTH MA DATE 1/18/2021 PERMIT 2"•�'o 7 JOBSITE ADDRESS 24 HASTING ROAD OWNER'S NAME JACOVIDES POWNER ADDRESS 24 HASTING ROAD TEL 727-688-4091 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:P1 RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES I I NOQ FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM —Ir 11 DEDICATED GRAY WATER SYSTEM _ )# DEDICATED WATER RECYCLE SYSTEM _ I DISHWASHER t, _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN _ e.. INTERCEPTOR(INTERIOR) [ I KITCHEN SINK �_. LAVATORY E I�_ ROOF DRAIN -- SHOWER STALL SERVICE/MOP SINK I TOILET Y IE 0 __ 0 URINAL I '. u I_ WASHING MACHINE CONNECTION I I '` 'I WATER HEATER ALL TYPES 1 WATER PIPING OTHER _ :___ Jh- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 12._ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY f BOND 71 - 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 I I AGENT fl 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 ac ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com iance all Pe . nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME MARK MORAN LICENSE# 20786 SIG U MPLI JP il CORPORATION DI# PARTNERSHIP®# LLCu# COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE R F C ryi `,, CITY FORESTDALE STATE MA ZIP 02644 TEL 08 648-2 FAX CELL 508-648-29311 EMAIL MORANPANDH@GMAIL.COM t DUILDir '1r B ._ ------ --- 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