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Home My WebLink AboutBLDP-21-006859 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u- * CITY YARMOUTH MA DATE 5/25/21 PERMIT# BLDP-21-006859 f JOBSITE ADDRESS 61 FLICKER LN OWNER'S NAME PACHECO RACHAEL A P OWNER ADDRESS 61 FLICKER LN WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW'.El 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 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 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 Gary Famigliette LICENSE fK191 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# f LLC ❑# COMPANY NAME GARY FAMIGLIETTE ADDRESS 67 MAPLE AVE CITY HYANNIS STATE MA ZIP 026014403 TEL FAX CELL EMAIL FAMCO@COMCAST.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 j� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ice'= _ll_ CITY/TOWN MA DATE PERMIT# -_ p //. / JOBSITE ADDRESS 6i/ ./c k F- /_-L OWNER'S NAME - .L.i C - Pl POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL[4 PRINT CLEARLY 'NEW:❑ RENOVATION:❑ REPLACEMENTS PLANS SUBMITTED: YES El NO71 I FIXTURES 1. FLOOR-' 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/01USAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN , _ , FOOD DISPOSER i FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) , KITCHEN SINK LAVATORY ROOF DRAIN , SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES � - - 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 ki NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Gil 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 El 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 coirli nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c• [> l \ -(� PLUMBER'S NAME GC,,�� C,r'✓�4 6 (�e Vt e LICENSE# 1/'I Ci/ SIGNATURE MP EX. JP El CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME_ iq )1/1(e) f DDRESS 6 -3 ti.-f t4��,�" 4CI 6CITY l 1ln�Ji?t STATE``l ZIP (��6 G �\ TEL S Q 9-7 7 S - S 5 .c FAX CELL EMAIL VOL.w\(C� CI Ccv1/1 cis , VC eV