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Home My WebLink AboutBLDP-23-001684 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/28/22 PERMIT# BLDP-23-001684 II JOBSITE ADDRESS 426 ROUTE 6A OWNER'S NAME Charles Roy P OWNER ADDRESS 426 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ED PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—. ,RPM 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION _ WATER HEATER 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 El 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 (Ronald Conte LICENSE 15696 I SIGNATURE MP El JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME IRONALD M CONTE ADDRESS 283 Cranview Rd CITY Brewster STATE MA ZIP 026312241 TEL FAX 1 CELL EMAIL Ircontemechanical@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El nff FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK =-a CITY P (- Ko '3 +)/r\ `l `__1�'_ Y Z MA DATE � 2 �� - � PERMIT# Z j � �� JOBSITE ADDRESS Il.� 6 A. OWNER'S NAME C hG ( 1-0 S 12 G Pt- �&h 724 ol�s 7 P OWNER ADDRESS f.+ 6 �T TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Ei PRINT CLEARLY NEW: Ef] RENOVATION:❑ REPLACEMENT:Et PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-I 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 SYSTEM DISHWASHER ' DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL < , SERVICE I MOP SINK TOILET '>< F C ., ' '� b.— URINAL I I . WASHING MACHINE CONNECTION z _ WATER HEATER ALL TYPES � 2 8 21172 ' WATER PIPING OTHER L.. ._. ...3 k.,UJ MINI-i1GF 1-4, t7ti ` I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[2" NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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. `'. CHECK ONE ONLY: OWNER ❑ AGENT ❑ � SIGNATURE OF OWNER OR AGENT 1 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 plumb ng 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 0 4 Co1, e LICENSE# 5 j 1 SIGNATURE LU BER S � I � 9 f7 MP[n JP[A nn ill � CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME !\ . `' C 0 A) I C M r C H AEI 1 C 4l_ ADDRESS Z. sS S C ail h v I e IA/ +` C CITY 6 rf,L4 $ STATE M 14 ZIP U Z b 3 ) TEL FAX CELL `) 0 5f- � 3 7 `9. 71 EMAIL C 0 to Fe W!e- c k GI Y) ) C G ) j' (-.iiivic,,,.,_c, 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