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HomeMy WebLinkAboutBLDP-23-005732 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,1 .( CITY YARMOUTH - MA DATE 4/13/23 PERMIT# BLDP-23-005732 JOESITE ADDRESS 9 IDLEWOOD DR OWNER'S NAME PROUTY DEANE P OWNER ADDRESS 9 IDLEWOOD DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ 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 1 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 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY El 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 Jeffrey Krula LICENSE#5036 SIGNATURE MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME (Jeffrey K Krula ADDRESS 11 CRESTWOOD DR CITY NORTON STATE MA -I ZIP 027661141 TEL I FAX I CELL -I EMAIL I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES S PERMIT# -- PLAN REVIEW NOTES r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Yarmouth ,j MA DATE 4/10/2023_ �PERMIT S 7 3 JOBSITE ADDRESS 9 Idlewood Dr I OWNER'S NAMEIBianca Ortiz T I P OWNER ADDRESS TEL 508-514-9427 IFAXT TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL .71 PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:[J PLANS SUBMITTED: YES❑ NO!1 FIXTURES Z 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM j '! r DEDICATED GRAY WATER SYSTEM r DEDICATED WATER RECYCLE SYSTEM r y t DISHWASHER ?+�'ti ' . 'la- DRINKING FOUNTAIN FOOD DISPOSER • P c. , pe al I.W eoA lisf Tlkit i FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL J SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER Tub/Shower Valve 1 . Shower Valve J INSURANCE COVERAGE: I have a current Iiabilit _insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES - NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSLRANCE 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. 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 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(Jeffrey K Krula LICENSE#C5036 SIGNATURE MP JP jJ CORPORATION J#4383 IPARTNERSHIPQ#r LLC❑# COMPANY NAME Bath Fitter ADDRESS 25 Turnpike Street CITY(West Bridgewater 'STATE Ma ZIP 02379 I TEL 508-521-2700 FAX 1 CELL 508-728-7718 EMAIL bostonplumbing@bathfitteccom • • r. - , €'. r' i 3t`a • ra • • ..1 7 ! 3i .. it • • V ti,, ( k - - - .. ! r. Yt` .. #_ .. " ' t' . • l.� . . �* •. - t, { w ,t_ _ • --- -- -- — --- - - .�- -- --� _. _. _. z - -^>...J++s—_-_ • . .. - 1',,, , ` , r -•r,„'.,. }