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Home My WebLink AboutBLDP-23-003759 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e._,y,,_. CITY YARMOUTH MA DATE 1/10/23 PERMIT# BLDP-23-003759 t.'.. JOBSITE ADDRESS 1 MALFA RD OWNER'S NAME DOUGLAS LISA A TR P OWNER ADDRESS C/O ANTHONY FEOLA 20 WARREN ST MEDFORD,MA 02155 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS RSM, 1 2 _3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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. 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 Karl Hanson LICENSE'2,0458 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KARL P HANSON ADDRESS PO Box 364 CITY Chelmsford STATE MA ZIP 018240364 TEL FAX CELL EMAIL sullyph@msn.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _:,__Ai �/ �,(_67—* CITY 1A-;" 1 7 '—' MA DATE l/S /3v�- 3 PERMIT# Z-3 - 3T157 — F JOBSITE ADDRESS I � �� 1.42c- c``'L1". OWNER'S NAME OWNER ADDRESS 1-I c. ,L• 1, -44. I y ) J 11 Sr J,-;7{ TEL e 17 -J`I 2( FAX CGS,_tcs '� TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALg' PRINT CLEARLY NEW:❑ RENOVATION:% REPLACEMENT:❑ PLANS SUBMITTED: YES❑ N0e 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 GASIOIL'SAND SYSTEM DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY t ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING I OTHER 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 YPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW l� LIABILITY INSURANCE POLICY 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 ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru 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 c with all P Rt prvvl5ton of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 'c rt t '(14 SC)."-- LICENSE# :AO Y5.`Z SIGNATURE MP❑ JP m f CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME_ cJ tyS �� i c•C(v, ADDRESS I U e-4 /• �r CITY U0(SO1 — STATE 144 ZIP 0 ) / TEL FAX CELL /7 —_3/U -7:330 EMAIL SviIt /1"- �^ 644 (D"^- r�z I�C�vCia -vk tIUZ. c 1U = 3}tJ ca.; _ I