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Home My WebLink AboutBLDP-21-000638 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • • CITY YARMOUTH MA DATE 8/11/20 PERMIT# BLDP-21-000638 JOBSITE ADDRESS 1229 GREAT WESTERN RD OWNER'S NAME JUSTIN EMERALD P OWNER ADDRESS 229 GREAT WESTERN ROAD SOUTH YARMOUTH 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW.0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO El FIXTURES i 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/OIUSAND 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 1 OTHER DESCRIPTION:boiler 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 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 Ralph Giangregorio LICENSE 91339 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RALPH J GIANGREGORIO ADDRESS 188 Route 28 CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL EMAIL office@3gsplumbing.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT FEES$ PERMIT# PLAN REVIEW NOTES t1 tp : p6 RC_Ei., MASS,4CHt)SETTS UNIFORM APPLICATION FO R A PERMIT TO PERFORM PLUMBING WORK CITY A.) i rvY-J MA DATE /-3 ? PERMIT Drv'?/-6l %fin �� JOBS1TE ADDRESS 7-Psi 6:7r:\.ocd- ( Ss/WA'"?A''? A OWNER'S NAME v -v LM tfLe OWNER ADDRESS SC 'Y`2 TEL 77`7 kL 'i 7FM TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL L PRINT CLEARLY NEW:: RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 N0 ( FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPEC IAL WASTE SYSTEM — 111—_____.DEDICATED GASIOIUSAND SYSTEM • - DEDICATED GREASE SYSTEM '*-- DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN --- - -- FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INT ERIOR) — KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK - _ TOILET URINAL r , WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES WATER PIPING OTHER k)i)04 r 4, i�,,I- v i . INSURANCE COVERAGE; " �� "' ^'i I have a current llabiIlxinsurance policy Or its substantial equivalent which meets the requirements of MGL C1I' air f IF YOU CUABIL�TYlNSIIRANCSE AOUCyTE Tti;TY AUGPE OF COVERAGE BY CHECKING THE APPROPRIATE 60X BELOW O 6 2020 Y OTHER TYPE OF INDEMNITY 0 BOND ❑ j 1 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requirede E NT Massachusetts General Laws,and that my signature on this permit application waives this requirement. 8y --— SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT 0 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 applfcallonwill be in pliancy with all Pertinent provision of the Massachuselts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �,2� i� ?��<--rz.; A, , ( C4cv�, q,„^,�,. 1 i'. LICENSE# � 33q - SKGNA, E MP'rQ JP❑ CORPORATION[24#iry•v L. PARTNERSHIP 0# LLC❑# COMPANY NAME -7-);!--.-- P(; 1.7.1.6;y",(-, ;+ 1-1eCj 1/161 ADDRESS i - MOIL, S7- CITY ne,...jr�, fr/-r STATE ill if ZIP (�(�/�,- TEL , FAX , Z 7 ��4. '1 CELL EMAIL �'1�?Cis)Cis) < �Pit),��nr7 j :, 4' � 0 I *4.41 „ - . ..• • - .