Loading...
HomeMy WebLinkAboutBLDP-23-002742 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/16/22 PERMIT# BLDP-23-002742 JOBSITE ADDRESS 16 PIERCE ST OWNER'S NAME PIERCE BENITA P OWNER ADDRESS PIERCE HERBERT B 11126 PIERCE ST WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:© 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 1 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 1 WATER HEATER WATER PIPING OTHER 3 OTHER DESCRIPTION:bar sink irrigation backflow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D 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❑ 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 Anson Celin LICENSE 32655 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ANSON CELIN ADDRESS 26 Capt.Blount Rd CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelin@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11=-ad= CITY 1.' 1- =1� � illurrL o✓vilcv MA DATE PERMIT# JOBSITE ADDRESS 1 (Q 12 i v-C c, `•,..)" OWNER'S NAME 'I �ei'L.I CA. ?i f—rGe POWNER ADDRESS I la ?i(XC& ,i- TEL S Gi- ' AX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB _- ---_--_-_�_ CROSS CONNECTION DEVICE —_ ---__-_— - DEDICATED SPECIAL WASTE SYSTEM -_ ----_--__-_ DEDICATED GAS/OIL/SAND SYSTEM -_DEDICATED -_---___- GREASE SYSTEM _----_-_ Ellill DEDICATED GRAY WATER SYSTEM -------------- DEDICATED WATER RECYCLE SYSTEMIII _- DISHWASHER _Ni ----�_--_-_ DRINKING FOUNTAIN __ —Mil FOOD DISPOSER __ —__— __ �_--■ FLOOR I EPTOA DRAIN ❑❑ ❑❑❑❑ 1111111111errall INTERCEPTOR(INTERIOR)LAVATORYKITCHEN INK I ❑❑❑■nI _ ROOF DRAIN NIIIIMr ilill,11111_ I SHOWER STALL f ■ il=__111111- SERVICE/MOP SINK � ___..L __NN,�_ I TOILET / • _ _____ ___ j URINAL ■_ _____`i�_-��� . WASHING MACHINE CONNECTION -M�__________�__ I WATER HEATER ALL TYPES WATER PIPING __❑____________ OTHER 1 in 1. , t. ' h ■ I 14'1� 't'�I')C{4'L. VA) 1, ") toe irxiC 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES LI NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [`J 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 I 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 mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME ,ky,r, (,1°il,1-t LICENSE# 3ZG5s SIGNATURE MP❑ JP[ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME a br) Pl,,,,A, .'-j A ADDRESS 2-6,. 0 Ain 0144n-1 -J CITY `),,�;t'4 L1uri'IG61th- STATE in A' ZIP 6Z6,6(, ?TEL'�/"� FAX CELL 5'a-1-UD-Ll'76.� f EMAIL nS6'1(,t,I,Fv(V/G, /reb—L'e.i✓)-) 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