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Home My WebLink AboutBLDP-23-004212 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/30/23 PERMIT# BLDP-23-004212 m ll JOBSITE ADDRESS 8 DANBURY ST OWNER'S NAME LEARY EDWIN M D OWNER ADDRESS LEARY ELIZABETH 46 SO LIBERTY ST BELCHERTOWN,MA 01007 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ 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 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 - WATER PIPING OTHER 1 OTHER DESCRIPTION:outdoor shower INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Christopher Salve LICENSE 1b800 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CHRISTOPHER SALVA ADDRESS 200 OLD BELCHERTOWN RD CITY WARE STATE MA ZIP 010829441 TEL FAX I I CELL EMAIL chris@ctsplumbing.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 - . , . . 12_.( c-Q 1 L) paj - dO-mui foci_0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -""11°g CITY $ (10 rNtOrl A_ I MA DATE f/3O7Z.3 PERMIT# a 3 - JOBSITE ADDRESS .. r Par( 5-1--- OWNER'S NAMES c& yJ M_1 P OWNER ADDRESS lb Sit L b 4 y TEL ! .. ..�.�.e.,��....�..:w_..� `��.� .��`� Y�/ Z FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: J RENOVATION: 7 REPLACEMENT: µ1 PLANS SUBMITTED: YES NO FIXTURES Z FLOOR-+ BSMJ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB .': CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM i DEDICATED GAS/OIL/SAND SYSTEM #' - DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM , DEDICATED WATER RECYCLE SYSTEM _ _ __ - __ DISHWASHER _, DRINKING FOUNTAIN _ ____IL FOOD DISPOSER �~ FLOOR/AREA DRAIN -7 INTERCEPTOR (INTERIOR) s KITCHEN SINK - LAVATORY I ROOF DRAIN - SHOWER STALL SERVICE 1 MOP SINK — TOILET . d t r URINAL _ 1 WASHING MACHINE CONNECTION I. WATER HEATER ALL TYPES WATER PIPING _ OTHER 7it1-6-460 : wT' __ -...a....._ - - ` 1i - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 4, 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 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 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 compl. ce wit ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /� PLUMBER'S NAME Christopher Salva ---.:j---- LICENSE # .158 _ SIGNATURE MP JP J CORPORATIONI# 91 PARTNERSHI # _ LLCD# I COMPANY NAME' CTS Plumbing & Heatin._ Co•' Inc ADDRESS 200 Old Belchertown Rd .1 1 CITY I Ware STATE rii"----1 ZIP 01082 I TEL 413-230-9705 FAX I ____ _ CELL EMAIL lchris@ctsplumbing.com I