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Home My WebLink AboutBLDP-21-006634 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK frA__ CITY YARMOUTH I MA DATE 5/17/21 PERMIT# BLDP-21-006634 1�==)/ JOBSITE ADDRESS 528 FOREST RD OWNER'S NAME TOWN OF YARMOUTH SENIOR CTR r 1.� P OWNER ADDRESS 1146 ROUTE 28 SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS 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/OILiSAND 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 El NO 0 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 Al Cassano LICENSE 9J15 SIGNATURE MP El JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 8 Fruean Ave CITY S.Yarmouth STATE MA ZIP 02664 TEL FAX ( I CELL 5087769536 I EMAIL SID@CAPECODMECHANICAL.COM 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 r MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK r - CfTY ��TN MA PATE CO!13 �bD-! PERMIT# • N OI= yRRiT>I JOBSITE ADDRR88 526 E$T �, Q AcRt M OWNER 8 NAME Ibk t.EV i t0 . 1 `� OWNER ADDRESS I\4Io RcuTE 28, 5.1RRfr U.ZN 1D TEL(5c6)314-160pl FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[i EDUCATIONAL ❑ RESIDENTIAL❑ PRINT PLANS SUBMITTED: YES 0 NO CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:I� FIXTURE81 FLOOR-•• 88M 1 2 , s 4 _ 8 8 7 L 8 r 9 10 11 12 13 , 14 BATHTUB •• ,----•• CROSS CONNECTION DEVICE I DE'Di �p.....,,,,ECIALWASTE SYSTEM 1 DEDICATED GASIOIUSAND SYSTEM _ DEDICATED GREASE SYSTEM -- DEDICATED GRAY TEST 8Y8TF�M DEDICATED WATER RECYOIE 8Y8IEM �...._._-, DISHWASHER �DRItiKINO FOUNTAIN FOOD DISPOSER , FLOORIARFADRAIN -- w, 1NT A,a-• •R(INTERIOR) _ ,.....__. KIT '11 `SINK f LAVATORY ..-----•--R ROOF DRAIN SHOWER STALL _ SERVICE!MOP SINK TOILET URINAL 1 WASHING MiLOHNE CONNECTION r . WATER HEATER AU.TYPES WATER PANG OTHER _ INS.JRAN0E COVERAGE: I have a cummt JIabillty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch,142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW WABIUTY INSURANCE POUCY CJHE OTHER TYPE OF INDEMNITY 0 BOND Q. OWNER'S INSURANCE WAIVER;1 am aware that the licensee does nj t 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 0 AGENT 0 SIG - OF OWNER •- 'GENT ere•yoe i la o 1 s e II an. nomu on two eu•m"a•or enters.roger.ng 1.aepp melon are ni -1_ • e•e o y o e•ge and that all plumbing work and InatellsUons performed under the permitlaeued for this appUaation will be inPertinent proviaton of the Masaaohueette State Plumbing Code end Chapter 142 of the General Lewa. , PLUMBER'S NAME AL CASSAND LICENSE# / <,Y'-- "- SIeNATURE MP ,1•, JP❑ Ud CORPORATION t .cll 40 PARTNERSHIP❑# LLC❑# COMPANY NAME' COO 6 trod k414,4Cleow'r ch-1 ADDRESS A Fri ei Dl Pc>e- CITY.,, c VtArOs kith. STATE'44/A ZIP 0 A, Gs Y. TEL SW~ 3s V-Z D/ � FAx.s .1 c v 2 r 7 CELL EMAIL i�