HomeMy WebLinkAboutBLDP-23-001445 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH —I MA DATE 9/19/22 PERMIT# BLDP-23-001445
°`° JOBSITE ADDRESS 2115 HEATHERWOOD OWNER'S NAME GWYNNE CAROL P TR
P OWNER ADDRESS C/O ROBERT CONNOR 352 HARBOR RD STATEN ISLAND,NY 10303-1820 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURFS • FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 , 1) 1�
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM T—
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTE _
DISHWASHER
•
DRINKING FOUNTAIN
i
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET
URINAL •
WASHING MACHINE CONNECTION
r
WATER HEATER
WATER PIPING
OTHER
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current liabilitLinsurance 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 NDEMNITY❑ 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 tie 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 Kurt E Mello LICENSE IAA SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# MA PARTNERSHIP ❑# LLC ❑#
COMPANY NAME Newpro Home Improvements ADDRESS 26 Cedar Street, Cedar
CITY HOLBROOK STATE MA —I ZIP 01801 TEL 9786600867
FAX CELL 7 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
\'es No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES PERMIT#
PLAN REVIEW NOTES