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Home My WebLink AboutBLDP-18-006307 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/10/18 PERMIT# BLDP-18-006307 l jJOBSITE ADDRESS 1121 GREAT ISLAND RD OWNER'S NAME CHACE BARBARA B TR P OWNER ADDRESS C/O POINT GAMMON 46 ABORN ST 4TH FLR PROVIDENCE, RI TEL 02903 TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL 0 PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YESE NO El FIXTURES 1 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES El 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 Kesuqs Lopez ' LICENSE#6301 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KESUQS LOPEZ ' ADDRESS 107 Meetinghouse Rd CITY Mashpee STATE MA ZIP 026492617 TEL FAX CELL EMAIL kees©evenflowplumbing.solutions ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No '+.. THIS APPLICATION SERVE AS THE ❑ ❑ DCDMIT FEES$ PERMIT# PLAN REVIEW NOTES • • . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Ya�rr� r\ MA DATE PERMIT d3�/ J 44343a'7 =Li= JOBSITE ADDRESS 101 6rea.1 Cad 12 OWNER'S NAME I ' IG!C�� c1ACcSe OWNER ADDRESS 1Io2i 6 CPi.O` ). 6ftQ'( TELwte3)Y '74737 FAX /6 TYPE DR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:6 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOX FIXTURES Z FLOOR--I BSb1 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 SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN T INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL 'S b` v l i WASHING MACHINE CONNECTION• ' (� • WATER HEATER ALL TYPES WATOTHER PIPIN(Th6 L OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YEVO NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ►7i 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 0 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' with all Pertine vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME e/eLs J 5 �o' Z LICENSE* 1L30? . IGNATURE MP 82 JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME V( bl�l �t/h�( 1 t� ADDRESS)O7 I /Icc_ `j h oust -04 CITY YrJ/ j� L° / '( A qq E / l / �/ STATEn, / �,� ZIP �L� //+ TEL(�Y/�3� f�� FAX jU CELL 77( -025D'�C�b0 EMAIL �GGc..> - 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 \N 4k)