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Home My WebLink AboutBLDP-23-002606 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/10/22 PERMIT# BLDP-23-002606 JOBSITE ADDRESS 16 JOYCE ST OWNERS NAME Don Delbauno P OWNER ADDRESS 16 JOYCE ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW:D RENOVATION:❑ REPLACEMENT:❑' PLANS SUBMITTED: YES❑ NO❑ FIXTURFS FLOORS-' RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 , 14 BATHTUB CROSS CONNECTION DEVICE 1 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 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 D NO❑ 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 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 William Pizzano LICENSE t8748 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME WILLIAM E PIZZANO ADDRESS 51 Maple CITY Rockland STATE MA ZIP 02370 TEL FAX CELL EMAIL will.pizzano@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �� 1i 2c.C..�> _;�_.a:' i ' I,f . kfl ( t' MA DATE l I z' PERMIT# Z z_ JOBS! ADDRESS 1(" ,ICYc❑' J� OWNER'S NAME DC* DaEiL'tl-k N g uOWNE ADDRESS TEL FAX .3U ll YPE ' baETFUCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL NEW:❑ RENOVATION:❑ REPLACEMENT:c( PLANS SUBMITTED: YES ❑ NO[ f FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM , DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ i_ DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ 1 . DRINKING FOUNTAIN , FOOD DISPOSER { , FLOOR/AREA DRAIN . INTERCEPTOR(INTERIOR) " . KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK _ — TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING . OTHER I 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 Y 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 ❑ 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 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 Pertir n rovision of the Massachusetts State Flumbing Code and Chapter 142 of the General Laws. `. �� PLUMBER'S NAME LICENSE# SIGNATURE-4""o MP Z JP❑ 1 CORPORATION❑# PARTNERSHIP❑# LLC❑# 4��1�j COMPANY NAME_ tA'1 Pre7 24(A,l0 ADDRESS 5( riAli P f1 Q- 3T- CITY RCcI<L J0 STATE in ZIP OZ37t1' TEL VI ?_6("' 15 FAX CELL K J( - I512_ EMAIL tt1Ll L_P1-27- A, 12 (7ilV 1(ICO ' . S 416 t t� iiZ st k J 1 r!.r:i"' 3 _ i,511.:3 e p 'n „;,ii fi' c2 4�, 1 � rj � _ _ r t" I - ti I SU t i • �tyti�l*9 _____I. i W 14 i Y.r2k3:f:J I tit 7 cl. st f—F '�' i t s . ,3 .r - I r Y 1 �, • : 33;tszfA i1iFidlii2 uar xf3 a�rtiU. .r _. .__.. _. xRQrkiiA; 3bQyq. �.�17�. t� -- +01t1 ate3r i:. _ .. .. 1 _�.,_ . r .-- fOrtgrVirtilX1111#10Tkras:av ., 1},. 1 �e .. . .. _ lei;.., IC TY3aA n q.7. tt} 0,. ?-:.) Ji! . - >r'=��ltadivii(mt�1�t - 3it?4 CfIC , k .'•_ _ .._ 'i _ 7 - s:$1aMoratwu c�... i j i :i. C= : ..