HomeMy WebLinkAboutBLDP-23-00597 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 4/27/23 PERMIT# BLDP-23-005970
JOBSITE ADDRESS 61 HOMESTEAD LN OWNER'S NAME GRENIER MARK R
P OWNER ADDRESS 61 HOMESTEAD LN YARMOUTH PORT,MA 02675 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0
FIXTURES 1 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
ROOF DRAIN
SHOWER STALL 1
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❑
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 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 nicholas theoharidis LICENSE 16980 SIGNATURE
MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ADDRESS P.O.Box 397
CITY ICeneterville I STATE IMA I ZIP 02632 I TEL
FAX I I CELL [ I EMAIL Itheoplumbing@yahoo.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
\'es No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY r•_.-4 Pc. r PERMIT 'Z3 `( 5576
,..„,-.4*„.; MA DATE 7 /-' L
JOBSITE ADDRESS (v 1 li"^^°ij'e 'OWNER'S NAME U 1 (-\1 L I Z ef—nS)C:
POWNER ADDRESS I/1 TEL s -'I I- TEL T LO .:Yti'1 `s`i 3 G FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIA1
PRINT
CLEARLY NEW:❑ RENOVATION:QJ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑
FIXTURES- 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/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM ,
DEDICATED GRAY WATER SYSTEM I
•
DEDICATED WATER RECYCLE SYSTEM '
DISHWASHER `
DRINKING FOUNTAIN '
FOOD DISPOSER -I
FLOOR/AREA DRAIN i
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY .
ROOF DRAIN
SHOWER STALL I 1 '
SERVICE/MOP SINK
TOILET
j URINAL i � E C F ; V F D
WASHING MACHINE CONNECTION - ) -7
WATER HEATER ALL TYPES {
WATER PIPING �,l Z6 vij 4
OTHER I � '
BUILDING DEPART MEIJr
' ur - It
-.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESyr NO E
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ,1 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
j 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 submtted 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. /J
PLUMBER'S NAME N , (-lc- '/'`'' LICENSE# I t ti V-_"'- SIGNATURE
MP, JP❑ CORPORATION❑# PARTNERSHIP ❑.# LLCZ#col —i Ji$
COMPANY NAME )I‘" PL",^J 4 Yeci,I ADDRESS (06 6o y- .3 I )--
CITY STATE ZIP v,�4 3 TEL O` 1))-6 39G it'
FAX CELL EMAIL e c VIA~S ^,r l� 9_4_1,i .l z
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