HomeMy WebLinkAboutBLDP-23-005255 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
n r CITY YARMOUTH MA DATE 3/24/23 PERMIT# BLDP-23-005255
-Il r JOBSITE ADDRESS 40 WILFIN RD OWNER'S NAME COUTURES MANAGEMENT CORP
OWNER ADDRESS 42 PLEASANT ST SOUTHAMPTON,MA 01073-9557 vU
P TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATION:El REPLACEMENT El PLANS SUBMITTED: YES NO
FIXTURES l FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1
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 1
LAVATORY 2
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2
URINAL
WASHING MACHINE CONNECTION 1 _ _ _
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 El
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 at 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 far 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 9839 SIGNATURE
MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME RALPH J GIANGREGORIO ADDRESS 188 Route 28
CITY Dennis Part STATE MA ZIP 02639 TEL
FAX CELL EMAIL offce@3gsplumbing.net
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE El El
FEES$ PERMIT#
PLAN REVIEW NOTES
I1 I r 1; K~ LL-: /2 •UU
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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- ' Ethit0 li:h \kg rn h MA DATE 31c33I s PERMIT#
MAR 2 i°20ff A DR,SS i-IO W i 1c-i 6. OWNER'S NAME.arkiYQfl (cl*.rQ
BOPNG iiEPAF2OWNER AD S 4 - Plo_t;6c-i^r- SC�L �1 1,roATEL L)I3-9-? - 13 a) FAX
BOP UUEPARTMkNT
YYP1=-OR—_—_OCOtUP_ANGY PE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL Pr-
PRINT
CLEARLY NEW:I] RENOVATION:❑ REPLACEMENT:B' PLANS SUBMITTED: YES❑ NO Ei
FIXTURES-1 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I , _
CROSS CONNECTION DEVICE - .
DEDICATED SPECIAL WASTE SYSTEM ,
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM '
r
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER • _
DRINKING FOUNTAIN _.
FOOD DISPOSER
FLOOR!AREA DRAIN
INTERCEPTOR(INTERIOR) ,
KITCHEN SINK i
LAVATORY - ,
ROOF DRAIN
SHOWER STALL j .
SERVICE I MOP SINK - ,
TOILET D
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 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY IV OTHER TYPE OF INDEMNITY 0 BOND 0
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 IDAGENT [3
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 appliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. fra.4./..et-7
PLUMBER'S NAME k U'h C"=iGv)1l ,,,"c") -1 LICENSE# c'(,3q SIGNA E
MP;jg JP❑ CORPORATION®#?7 'tCi C PARTNERSHIP El# Lc El#
COMPANY NAME -.c Pk)vti6i 4- yeC - ADDRESS r/V'yS IV C ct
CITY 0)Pil y/1 i 5 i%,�-f STATE LA- ZIP Ci r�-(G�3 y TEL
FAX S3`6 Li (c[.t S 1 CELL � EMAIL dr j C� �C.,3PUrhlji✓1y"r� • ry21