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Home My WebLink AboutBLDP-23-005734 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK a; (T CITY YARMOUTH J MA DATE 4/13/23 PERMIT# BLDP-23-005734 JOBSIT-ADDRESS 113 HIGHBANK RD OWNER'S NAME SAKOLSKY-HOOPES GABRIELLE E P OWNER ADDRESS 113 HIGH BANK RD SOUTH"ARMOUTH,MA 02664-3131 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YESD 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 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE C:ONNECTION 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 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 Jeffrey Krula LICENSE#5036 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME [Jeffrey K Krula ADDRESS 11 CRESTWOOD DR CITY NORTON STATE MA 7 ZIP 027661141 TEL FAX -1 CELL 7 EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK et -4 CITY Yarmouth MA DATE 4/6/2023 (PERMIT# �" 3 - 5 7 3 y JOBSITE ADDRESS 113 Highbank Road OWNER'S NAMEIGabrielle Saolsky OWNER ADDRESS I TEL15083982601 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL '1 RESIDENTIAL ;I PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:[ PLANS SUBMITTED: YES ' N00 FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB J .J CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM } '� 4 DISHWASHER n — 1011 DRINKING FOUNTAIN � Ah?•,P. FOOD DISPOSER FLOOR/AREA DRAIN meter INTERCEPTOR(INTERIOR) Amor KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER Tub/Shower Valve 1 Shower Valve INSURANCE COVERAGE: I have a current liabil'l�t Linsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES HE 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 �i__ 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 t e est my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in m ance with all Pert t pr vi ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Leffrey K Krula (LICENSE# 105036 SIGN TUR MP ' JPL] CORPORATION r1#4383 (PARTNERSHIP❑#r 1LLC❑#r— COMPANY NAME JBath Fitter ADDRESS 25 Turnpike Street CITY West Bridgewater I STATE Ma ZIP 02379 I TEL 508-521-2700 FAX I 1 CELL 508-728-7718 EMAIL bostonplumbing@bathfitter.com - I 111111,