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HomeMy WebLinkAboutBLDP-23-00162 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -'�w7 CITY YARMOUTH MA DATE 9/27/22 PERMIT# BLDP-23-001628 11 a� JOBSITE ADDRESS 11 CROSBY ST OWNER'S NAME gary fincus P OWNER ADDRESS 11 CROSBY ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D PRINT CLEARLY NEW:© RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURFS FLOORS—a 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 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING 1 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❑ 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 Peter Fencer LICENSE 18512 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME PETER J FENCER ADDRESS 74 WINTER ST CITY STOUGHTON STATE MA ZIP 020722844 TEL FAX CELL EMAIL petedencer5@gmail.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 Vit*: E� ITX < 4 c/ 'h,t MA DATE �/. / /12 PERMIT# 13 " Ic:. c i i ~ � EAD SS / u1G Si�c � Cre.y-� 7 v SEP 2 I"' i C� OWNERS NAME / din c � OWNER DR SS 54// TEL�'7 � 5 �1 J-2 FAX B:"�DING DEPARTr1! NT TYP_F AR--;S CUPANCY PE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIA, PRINT CLEARLY NEWS RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED; YES❑ NO❑ FIXTURES 1 FLOOR-+ 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ' DEDICATED WATER RECYCLE SYSTEM ' DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN ' INTERCEPTOR(INTERIOR) , KITCHEN SINK ' LAVATORY ROOF DRAIN ' SHOWER STALL • SERVICE I MOP SINK 1 TOILET URINAL . I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES / j 1 WATER PIPING / OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE 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 It Massachusetts General Laws, and that my signature on this permit application waives this requirement. •T CHECK ONE ONLY: OWNER ❑ AGENT ❑ Z. 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 compliance ' 1 rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ��?C! / c'/�4" LICENSE#/25�/2 SIGNATURE MP54 JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ‘-k- ` 4e'c� "���'- i47iADDRESS 7'z Gy 1 n 4- oc� CITY --(7Dcnyi STATE/2V ZIP 49-2o72 TEL6/2 S `2-3999 FAX CELL /7 —5*92 2 2 EMAIL ,ve, 4,l.� �d-'74e' -(-0� 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 •