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Home My WebLink AboutBLDP-21-000740 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 11,401CITY YARMOUTH MA DATE 8/16/20 PERMIT# BLDP-21-000740 JOBSITE ADDRESS 18 WIANNO RD OWNER'S NAME JUDITH NELSON P OWNER ADDRESS 18 WIANNO RD YARMOUTH PORT 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL CI RESIDENTIAL D PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO 0 FIXTURES 1 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 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY E 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 Joselin Sanchez LICENSE3/1804 SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOSELIN C SANCHEZ ADDRESS 108 BAYVIEW ST CITY WEST YARMOUTH STATE MA ZIP 026738211 TEL FAX CELL EMAIL giovannisanchez524@yahoo.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 J. 11 f 1 1 i pe, Ic E i &. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK L_'`� CITY ��?Q[J��/J MA DATE 70 PERMIT# 3L D 1 /"0607110 1r r'> JO8 TE ADDRESS /CIn nd OWNER' M S22 1-7 P „..._____., 4 OWNER ADDRESS -Qm gS' __ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL, PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[ .. PLANS SUBMITTED: YES❑ NO❑ FIXTURES-1 FLOOR-4 ' 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORYX ROOF DRAIN � SHOWER STALL L'`ry�E 10 SERVICE/MOP SINK " .1 �� j TOILET /I URINAL d� WASHING MACHINE CONNECTION IC Cott WATER HEATER ALL TYPES '2:'-1-- �� WATER PIPING `..,j OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i$ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW / LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I a 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 ail plumbing work and installations performed under the permit Issued for this application will be in compliance with I Pertinertirovision of the Massachusetts Stale Plumbing Code and C ter 142 of the General Laws. PLUMBER'S, ------- �'tt b",) c,,,,di,,?„, LICENSE#3/ pj O SIGNATURE MP❑ , CORPORATION❑# PARTNERSHIP # LLC❑# COMPANY °v � ��1' ' ' h a� AS /(/ .Q CITY6s71- ...e.-yyt0d TATE //. ZIP O 4. -13 TEL.-5;8 3 -B e7 FAX CELLvI� /5 3.7 EMAIL 0 eAf"17 :5-ow 4aZ-SZvC g,400,.