HomeMy WebLinkAboutBLDP-22-001327 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH ] MA DATE 9/7/21 PERMIT# BLDP-22-001327
JOBSITE ADDRESS 34 KELLEY RD OWNER'S NAME LEVERONE JOHN D JR
P OWNER ADDRESS LEVERONE SANDRA A 34 KELLEY RD SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL Cl RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ 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
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 1
OTHER DESCRIPTION:valve
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO Cl
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❑
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 David Renzello SR LICENSE V1886 SIGNATURE
MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME ADDRESS 16 1/2 Foley St
CITY Attleboro STATE MA ZIP 027031806 TEL
FAX CELL -1 EMAIL PERMITS@REBATHNEWENGLAND.COM
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑
FEESS _ PERMIT it
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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JOBSITE ADDRESS : 3 (4v-eat/ go OWNER'S NAME -1-oh,1 Lev(.1%0, c.
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OWNER ADDRESS I,
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TEL
FAX I I
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TYPE OR OCCUPANCY TYPE COMMERCIAL ! EDUCATIONAL i RESIDENTIAL F.
PRINT _ .
CLEARLY NEW: RENOVATION' ' ' REPLACEMENT: v i PLANS SUBMITTED: YES " i NOEj
FIXTURES -1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB -------7, i c----1
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CROSS CONNECTION DEVICE 1 1 ,r1 lig]
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,,,,,,,,,,,A,,,,=•-..,FT,,,,_+7,-,ate,,,,,,,,S,--M7 ,' ',,-.411.-- `,..3.".',0.,'r.A -,...",m2`.'' - -A-^ - I
1 *-"1 1 'V r.---- -
DEDICATED SPECIAL 'NASTE SYSTEM I t m , I II .-,. ! ! i 11 I ir -ii ir- i
....„,,,i,..,.„..„....„,_,._ ._ ,,..„.„....,.„: .,,..•.,,, lMA L.,,,,,b..{,^..r, ' - -,,,,,,,,,,,-,-,3 ., : ,,,, ,,a, , k,„, ,—,,,c,
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DEDICATED GAS/OIL/SAND SYSTEM III . li AI i ____il i J 17-1, li I
-, t-r ._2j. W-..,eleri....5-4. ,r1,,,,J..,... '..,--,,, ,--,,,,,:,..- ,,=-:
..---...-...,-....7,.......-------- . .............. ..,..........- 1.
DEDICATED GREASE SYSTEM 1 4 . li ji j ': ii_. JI li---1.- 1 i, i
.„,..._ .,.....„,_,...,„!, ,.•_____. 1,=, ',....,-ee.:tr.., -,-,--,A,,,- -',..---,-,,,,..',,...,-„, ,------ -i- ,7,-,7,.-L...-,--,,-,,,,, ...,-..--^,- ..-....- -..:,--,,,,'...,-472. --,
DEDICATED GRAY WATER SYSTEM F-11--- 11. _ . ,11- 11-1 l'i li il 1TJ !L iL . ]
DEDICATED WATER RECYCLE SYSTEM r— !I r----
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. • i j j ,A I 31 A 1 • 1 L 4
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„, .._„__.:::. _ „x....„,,,, ._ „,_,...„..,_,N„:—...,,,,.,,...__t . ,.., . _...11.,.,.....---- .---...4.--- -„,-.....—.]
DISHWASHER Pi 7, 3' „ ii
1
DRINKING FOUNTAIN JTTJL -,t,-,e 11 -L
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FOOD DISPOSER
1---- 1 t: -- : . 7---*-11----- —'-f .''r 1, 1
FLOOR /AREA DRAIN ,-1
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INTERCEPTOR (INTER OR) L i , , 1,
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.,7. ,r,,,,, _
KITCHEN SINK r = t . _
a.,i r---- - 1 7-- 1,-- — --If ----7- 7,1
LAVATORY t
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ROOF DRAIN 1 iL ' ' 3, g r----- --- ,i .,•:
SHOWER STALL ,
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L.4,....._ ,
SERVICE / MOP SINK
TOILET 1 ,
URINAL t _,ir----
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WASHING MACHINE CONNECTION ,
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WATER HEATER ALL TyPES !:-.
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WATER PIPING A 1
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OTHER valve ___
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INSURANCE COVERAGE:
I have a current liabilibLinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ' v 1 NO Li
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
El
LIAB BOND ILITY INSURANCE POLICY - v OTHER TYPE OF INDEMNITY : '
i 1 --1
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 AGENT
SIGNAT JRE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true an ac rate e st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit a pr vision of the
Massachusetts State Pluribing Code and Chapter 142 of the General Laws.
1 -----1
M.'
PLUMBER'S NAME !David M Renzello Sr [LICENSE # 10886
II SI NA URE
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MP v JPI i CORPORATION 1#' PARTNERSHIP #: I
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COMPANY NAME HIP Construction LLC I
, ADDRESS 2C Morgan Mill Rd
CITY'Johnston STATE L IR! I ZIP 0 2 9 19 i 7.'' '''' ''''' ''' ' '''''''''''''''''''''.`'''''''''''''' 's ".•-'".--"'.r..
TEL 1401-942-7897
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FAX i .; CELL EMAIL „permits@rebathnewengland.corn
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