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HomeMy WebLinkAboutBLDP-23-005961 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e CITY YARMOUTH ] MA DATE 4/27/23 PERMIT# BLDP-23-005961 t=is F, JOBSITE ADDRESS 96 HELMSMAN DR OWNER'S NAME GRIECCI JAMES P P OWNER ADDRESS GRIECCI DEBRA R 96 HELMSMAN DRIVE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YESD NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 OTHER 2 OTHER DESCRIPTION: ejector pump bar sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 plumping 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. PLUMBERS NAME John Callahan LICENSE 2t1648 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [JOHN F CALLAHAN ADDRESS 520 S FRANKLIN ST CITY HOLBROOK STATE IMA I ZIP 023431830 TEL FAX CELL 6177800468 -I EMAIL johnc.mechanical@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __ �� CITY y�}�/r.�J {� 1. MA DATE 'A�7 'A� PERMIT# L 3 - 5 c7 7 ��� JOBSITE ADDRESS /.• A�/,)S/2-2ft/-7 ,c, " OWNER'S NAME 6r'.9'? -94f}4,/) POWNER ADDRESS 9i9/7V., TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: E RENOVATION:Q.--- REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB '>.< I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 4>`\ ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER � c a.(- ,S;v5 "-g< — BP)r.S;n INSURANCE COVERAGE: �®®' F I have a current liability insurance policy or its substantial equivalent which meets the requirements of MqL C . 2pg[ p- IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELO ' gi? LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 11BOND ❑ I . 'R 2 5.i �� ` G UEH kTMENT OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage requirie b9 _meter 142 of the ___ Y i' Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [11AGENT ❑ t� SIGNATURE OF OWNER OR AGENT ::1 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 LICENSE# SIGNATURE MP ❑ JP©/ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME �d�/7 7l X 7 ADDRESS ///Y./22/3'"`H 5j/60-af9 CITY J/r9 V, .M f T .9 STATE 72' ZIP G �7� TEL G/7 v- oyes' FAX CELL EMAIL TO�,�n e..!-7eci- ,u4-I. <eg i- ,f,A,s. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT It PLAN REVIEW NOTES 1