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Home My WebLink AboutBLDP-22-00775 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r CITY YARMOUTH MA DATE 4111122 PERMIT# BLDP-22-005775 �tl JOBSITE ADDRESS 34 HIALEAH AVE OWNER'S NAME Grace Volpes P OWNER ADDRESS 34 HIALEAH AVE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES El NO El 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 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY❑ BOND El 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 allot 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 Zachary Lucas LICENSE 16865 SIGNATURE MP El JP El CORPORATION ❑# [ PARTNERSHIP ❑# LLC ❑# COMPANY NAME MID CAPE MECHANICAL ADDRESS 300 Queeen Anne Rd. CITY Harwich STATE MA ZIP 02645 TEL L FAX CELL EMAIL midcapemechanical@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ 0 FEES S PERMIT# PLAN REVIEW NOTES fr MASSJ o� ACHUSETTS UNIFORM APPLICATION FOR A PERMIT/ TO PERFORM PLUMBING WORK R. r�� y ^`./_` Li. 7a( vki iTiVl MA DATE !s!Z Z- PERMIT# 2. 7 ._ S 7 S- I • tyy [ 1I I~y 1220B ITE ADDRESS �`{ . k a k K r� 1 / OWNERS NAME 6 sz�c� �01 0 ER ADDRESS 3' 1�, cl /yet, /+� TEL FAX B ILDINP�Ea ARTMENT By. ' ' OR--E)GGIJP4,NCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0- PRINT CLEARLY NEW: ❑ RENOVATION: [' REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO[11.--- 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM , DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER F DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ` r KITCHEN SINK It f _ LAVATORY - ' ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL . j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ' iI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES eNO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY El" 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 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. T CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT L1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate o the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com Iiance with all ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Zo-E-1/144, ait, v( 3 LICENSE# I I' &' SIGNATURE MP DV JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME Wl.+ C--C(K C ha«.^6v) ADDRESS PU 1J0x 4') 3 D CITY W , 6-6.aitlAct STATE 1M ZIP UZ ,6 / TEL `5 0 8 ' 2`t'6 ^ ?2 77 FAX CELL EMAIL !`iaC/ZKA!c.1-10.ie7i`C.. JPj .t • r ,`Le.4;... 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