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Home My WebLink AboutBLDP-22-003976 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, _ CITY YARMOUTH J MA DATE 1/18/22 PERMIT# BLDP-22-003976 JOBSITE ADDRESS 142 LONG POND DR OWNERS NAME Adam Miller P OWNER ADDRESS 142 LONG POND DR SOUTH YARMOUTH,MA 02664-4144 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ FIXTIIRFS FLOORS— RPM 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 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❑ 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 El 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME Adam Hufnagel LICENSE 18256 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADAM HUFNAGEL PLUMBING& ADDRESS 167 Carriage LN HFATINC I I C CITY 'Barnstable STATE 'MA I ZIP 02630 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 zvith, -MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1• �� CI az MTV MA DATE i I 1 ) 2 Z PERMIT# 2Z- 3 j � 1 4 2O2QBSI E F()DRESS I Z- L 3 iCV\ P TA TV�OWNER'S NAMEc� 4cS,C4tA'\ t'A �{/�r/ ADDRESS �� T - O !t'�3 6 FAXBUILDI G DEP/ARC CY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 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 GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ _ DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER • FLOOR/AREA DRAIN _ J INTERCEPTOR(INTERIOR) KITCHEN SINK T LAVATORY J • ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET L — URINAL WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING 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 THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V' OTHER TYPE OF INDEMNITY ❑ BOND ❑ i 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 ICI I hereby certify that all of the details and information I have submitted or entered regarding this application are e and accur to o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pliance it II ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ik\coA f1/\ctoe--- 1 LICENSE#I`,ZS b SIGNATURE MP L LY JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC r2d 3 7 �Z COMPANY NAME kI40'"\ 1-1u C'gtC) ( ADDRESS I ( N4 U){' 1- cry 1 \ STATE tiV Zip° Z-b 3 of TEL FAX CELL s v 6 —3I 7' 7ci iEMAIL j 1f' `'I cCJr lC `ts-1 •i -- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT I FEE: $ PERMIT # PLAN REVIEW NOTES