HomeMy WebLinkAboutBLDP-23-005612 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 4/10/23 PERMIT# BLDP-23-005612
JOBSITE ADDRESS 657 WILLOW ST OWNERS NAME GENTILE LOUIS J JR
P OWNER ADDRESS GENTILE DENISE A 5 MEADOW LN WOBURN,MA 01801 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YESD NO❑
FIXTURES t FLOORS-, BSM 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 2 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2 1
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER 1
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 El OTHER TYPE OF INDEMNITY El BOND 0
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 Charles Delvecchio LICENSE 18269 SIGNATURE
MP ❑ JP El CORPORATION El# PARTNERSHIP El# LLC ❑#
COMPANY NAME CHARLES M DELVECCHIO ADDRESS PO BOX 719
CITY FORESTDALE STATE MA ZIP 026440702 TEL
FAX CELL EMAIL capeplumbingandheating@gmail.com
s
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE
FEES$ PERMIT#
PLAN REVIEW NOTES
APPLICATION P 3 top.-- z 3- aO.5(.0/ -
1i E -- _ - ^ - _ • )• T TO -ER?CPil,r1 PLUME:N3'11woR:,
CITY! Yorrno � MA DATE, ^1(U•�z-� ;PERMIT#
-'.. � JOBSITE ADDRESS I (rt ‘..7 (./V) I (tom ST ; OWNER'S NAME; t - cJ,S'T '1,
P I OWNER ADDRESS I 1 T ELI 'FAX'
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ' I RESIDENTIAL 12
PRINT
CLEARLY NEW:V RENOVATION:❑J REPLACEMENT:❑ PLANS SUBMiTTED: YES❑ NOL
FIXTURES Z FLOOR— 8SM 1 1 2 ! 3 1 4 j 5 6 i 71 8 9 1, 10111 ' 12 13
BATHTUB 1 1 _ i ! j I
�ROSS CONNECTION DEVICE I + l
DEDICATED SPECIAL WASTE SYSTEM . I 1 i I 1 i
DEDICATED GAS1011.1SAND SYSTEM . i I i
DEDICATED GREASE SYSTEM J I ' I
DEDICATED GRAY WATER SYSTEM i I I 1 ! I j
DEDICATED WATER RECYCLE SYSTEM f ! -
)ISHWASHER f I I I i
1RINKING FOUNTAIN ! I '
OOD DISPOSER , A I I
LOOR/AREA DRAIN I i l i
ITERCEPTOR(INTERIOR) t 1 i I
1TCHEN SINK I I tI I I
WATORY 1_ ' I ? 1
-lOF DRAIN
OWER STALL I t 1 i I i j _
!RVICE 1 MOP SINK i I • I c
- DIETi a. I
.) FINAL , _ ? _ _ L
CS Al-' -4�23,
45HING MACHINE CONNECTION j 1 ( I ,
C_ ;TER HEATER ALL TYPES ' t
Ii
er ;TER PIPING ( l j f ! I BIIILDIN UE'r). I NT
C3 'HER E3Y ,-
Cc�,�I_P i I i I i I 4
ti I j
I
,tr.? i I i I 1
INSURANCE COVERAGE:
6 we a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES DiNO ❑
c1 'OU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
-10 LIABILITY INSURANCE POLICY OTHER TYPE Or',NDEMNITY❑ BOND ❑
C.
NER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
;sachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY'-OWNER 0 AGENT ❑
P SIGNATURE OF OWNER OR AGEN I
S. eby certify that all of the details and information. nave suamitted or en:e•ec regarding this application are trug nd : ' to the best of my knowledge
9 that all plumbing work and installations performed.jncer the permit iss,:e:'7r this application will be in com ianc :• Pertinent•rovisi•n • e
sachusetts State ( ,Plumbing' Code and C ter 142 cf:he Genera'Laws. `i
v16ER'S NAME I h- _�l^� r [) ;LICENSE r: 1 "J SIGNATURE
ZI V JP❑ CORPORATION❑#I ?PARTNERSHIP❑#I—I LLC❑#J I
U ?ANY NAME i C ? e+ 1+ ADDRESS_ c70 vx -7c,�
�j STATE i '1�{7 ZIP 1 FJ7 L1 9
1 TEL — L7--6/l 2_1
CELL l '1Z 1 EMAIL i
' 2
S APPLICATION SERVES AS THE PERMIT YES N0 FEE:$ �i'i/ V
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