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Home My WebLink AboutBLDP-2-002258 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH —1 MA DATE 10/19/21 PERMIT# BLDP-22-002258 JOBSITE ADDRESS 70 GREENLAND CIR OWNER'S NAME Mario Ranalli i) OWNER ADDRESS 70 GREENLAND CIR YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS—, RSM 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 SERVICE/MOP SINK TOILET URINAL I WASHING MACHINE CONNECTION WATER HEATER 1 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 jeff normandy LICENSE*750 SIGNATURE MP E JP ❑ CORPORATION El# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS P.O. BOX 923 CITY brewster STATE MA , ZIP 02631 TEL FAX CELL 1 EMAIL jnormandyhvac@gmail.com S310N M3IA3H Ntlld #111,1H3d SS33d 3H1 SV 3AH3S NOIiVOIlddtl SIH1 ON saA S31ON NOI1DHASNl"IVNld A1NO IS11 3:)IdlO HO3 MO33R S I1ON NOIL 3dSNI 9NI 1I1I1'ld H91O11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l -='it%=-., CITY tGI "w 1 MA DATE ,vt� l l PERMIT# 2 ." / ii f tt nn JOBSITE ADDRESS �U vcC�'-`'.1�'�3 C�( L Q OWNER'S NAME 1/14C . G tNbeti`�, POWNER ADDRESS — 5(---ArZ TEL cOg k //6336 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL- PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT PLANS SUBMITTED: YES❑ N . FIXTURES-1 FLOOR BSM 1 2 3 4 5 16 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS10IL1SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM lid �� DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET ___ ______��-_� URINAL WASHING MACHINE CONNECTION MI. WATER HEATER ALL TYPES IMII____�� WATER PIPING OTHER 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 gi 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 Pertinent provisiod of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .4- J_ PLUMBER'S NAME LICENSE# (i : !`�, SIGNATU&E Ci' MPS JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ti t i/ a-teran.1 fk-4 11''1 i4A C ADDRESS r / CITY ��v' Qf STATE r v, ZIP 6 IL 3 / TEL 5 6 z. ^ f(-t' FAX CELL EMAIL /ii4'�-`""��v1 I;✓CI Al-11I •C'k