The URL can be used to link to this page

Home My WebLink AboutBLDP-23-000505 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/1/22 PERMIT# BLDP-23-000505 JOBSITE ADDRESS 96 POMPANO RD OWNER'S NAME STOCK DAVID K P OWNER ADDRESS STOCK PATRICIA T 20 VENTURA ST DORCHESTER CENTER,MA 02124-5804 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12J3 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 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 infomration 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 lome jussila LICENSE 20971 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 84 Bog Lane CITY WEST HARWICH STATE MA ZIP 02645 TEL FAX CELL 5087768943 EMAIL Iomejussila@hotmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El rimnaarr FEES$ PERMIT# PLAN REVIEW NOTES � y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ". `07.1 Z I roi0 L, l r_ MA ATE 001 L• , c� PERMIT# 2 3 ' c,'c � 2 9 I DRESS `"7-6 Pj2)/,'i G1/',b 6'>ci OWNER'S NAME 1C(( 1('1 C,(-- jto C OWNS DRESS ,)4 J;7 Q. TEL FAX cU ING DEPARTMENT I iy I_PE OR___ Y TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL l}'kINT CLEARLY NEW: ❑ RENOVATIONS REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ N& FIXTURES 1 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 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I • DRINKING FOUNTAIN FOOD DISPOSER --- FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK / LAVATORY ROOF DRAIN SHOWER STALL • SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: l I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLIO OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the J Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z 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 d accura best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ' nce ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE#3670 . SIGNATURE MP❑ JP , , CORPORATION❑# PARTNER IP❑.# LLC 0# / / - CITY COMPANY AME/ (r 1 /1 l ,_ ADDRESS h �T ZIP TEL / .1 5TA )) FAX CELL EMAIL /dJ'A f L�i5)4( Ic 7/+iq)2 (C44 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 • - 1