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Home My WebLink AboutBLDP-22-001792 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY EARMOUTH MA DATE 9/29/21 PERMIT# BLDP-22-001792 a [ b JOBSITE ADDRESS 36&38 HUDSON RD OWNER'S NAME Lucas Vieira P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS I FLOORS—, RSM 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 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❑ 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❑ 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 ssued 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 Anson Celin LICENSE X2655 SIGNATURE MP ❑ JP El CORPORATION ❑# [ PARTNERSHIP ❑# LLC ❑# COMPANY NAME IANSON CELIN ADDRESS 26 Capt. Blount Rd CITY South Yarmouth STATE MA ZIP 02664 TEL FAX —I CELL I I EMAIL ansoncelin@yahoo.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK "�=? CITY I/1/ (4.6.,-avuvrlitiMA DATE -2 ! LI PERMIT# 2 2- 17 7 2- JOB SITE ADDRESS ' �a 1+4 L4 KJLS<r`) R) OWNERS NAME L l .%�t s (L• c POWNER ADDRESS 3 frlk,, d R rJ TEL r]7C f-g 3G-22 C7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL IYJ PRINT CLEARLY NEW:E. RENOVATION:[' REPLACEMENT:❑ PLANS SUBMI I I ED: YES ❑ NO❑ FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB _f CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILfSAND SYSTEM ---i DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM DISHWASHER ' DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN — INTERCEPTOR(INTERIOR) KITCHEN SINK i LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION j WATER HEATER ALL TYPES WATER PIPING OTHER i INSURANCE COVERAGE: I have a current liability 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 UABIUTY INSURANCE POLICY Cir OTHER TYPE OF INDEMNITY 0 BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1` 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 Pertine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ArL` PLUMBER'S NAME LICENSE# S S SIGNATURE MP El JP[17,Y //- CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Ati, nn Le I In ADDRESS Lt P�cti i 1 8/(ii A(1i- ✓* ) CITY _sSc)ut-0-1 44 nznt Ctti STATE /11 '` ZIP (26-C1j TEL FAX CELL 45—Cg-2"4L- C( 47rr)• 60,.77 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT it • PLAN REVIEW NOTES • •