HomeMy WebLinkAboutBLDP-21-000616 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 8111/20 PERMIT# BLDP-21-000616
JOBSITE ADDRESS 66 COOLIDGE RD OWNERS NAME CONNORS JOSEPH D
P OWNER ADDRESS CONNORS TRACI E PO BOX 303 WEST YARMOUTH,MA 02673-0303 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:El RENOVATION:0 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
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
WATER PIPING
OTHER 1
OTHER DESCRIPTION:Boiler
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY❑ BOND❑
OWNERS 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.
PLUMBERS NAME Ralph Giangregorio LICENSE9.339 SIGNATURE
MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME LLPH J GIANGREGORIO ADDRESS 188 Route 28
CITY Dennis Port I STATE MA ZIP 02639 TEL
FAX J CELL EMAIL office@3gsplumbing.net
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
r1IASSACHUSE s UNIFORM APPLICATION FOR A PmArr TO PEORIl PL UiWg1 MG WORK - i
IF-,. t_____ d . .
V _ C:IT`rr '�' • Yf�! Mo a `.� f A ?ATEI,_. ./ _._.1 PERffirr# A-Alrj-- / "CVO-
C 61/4
JOB ADDRESS .t 6 wd _/� j OWNERSNAME; 70- � �vr ri f- _ k
I ' p
CV ERADN S f /1,11 �.h. e4:4.� Nig, I TEL,S?t �Yr_o CS 4FA
- TYPE OR OCOUPANCYTYPE CQ�C!ALD EDUCATIONAL 47.40 - RESIDENTIAL •
PRINT
CLEARLY.LY MEW El - t t3 Ai It REPLACEMENT: = PLANS Si. MI"t`f : YES 0 SkIO
FIXTURES 1FLOOR-` - 1 BSM J -1 1 2 1 3 1 4 1 5 1 6 1 -f 1 8 1 9 1 10 1 11 r 12 . 13 1 14
_
1 BATHTUB • II 14 11 -' i _ ii 3i . id I <<. ._._ I._ __Ii
t CROSS CONNECTION DEVICE • `_ _1- ---
cEcic SPEGIAI:Sfi:As i ESYs�-Enr ;— — _�.r; - ._ I _il Pi_.1..__
Ji
t►i ED __Ig. . _1(�-1� Il �!� _ ..x_...1 .---J i -- r-I--• --1
c7�it;ATl� GASfUtL[Sti''iQ SYSTEM �� =;J._.._...,..I'1 _ � - -... .. .,J�:, .. �_.. " _I
OE ATED _ -;1�-- ^LIMPNAM l� L .. =1 1� _.
DEDIC I GREASE SYSTEM t M�___ii tl_ �____`� 1fi_. t ! Ma '" _
DEDICA►ED GRAY I T ER SYSTEM I 'l.____._, ?1;-- 'f—_y ii ii - c 4`I 11 11r
. TECC FED WA T R. ECYCLE SYSTEM II ~, I - q i.I n d - Il__ I; Iti II s
DISr:N : R q - I - �I - l�_.iI rl..-_.._._. _i v.! L 4I. '1 J}
:ONION G FOUNTAIN t_AIN 11.__. _1. 1L ' - • i _ 7 _ - _-,r•_..i' ___11 111_-�_1. ., t---�-_:I
FOOD DISPOSER 11 I:1 (I{ i1. 1 __II_ � II �I = - 1; u _-t_
i - h y, t -.
DRAIN it �I____,_ ;___.__ I .__._. � L I G�=1—II I :� r� h( �(_.r.=a
FLOOR I AREA DR
INTERCEPTOR ERCEPTOR(INTERIOR) II i, II q q E4 t C _-E_____E .E ti I.' j _I
KITCHEN SINK - Ii - 11 It ill •i I I r r i a i 4a
L;" T ORY I .l - _i I - r j si ;+ s i' `
ROOF DRAIN - ; `—
iii III_ =1. j, . I,I ' r D _r II— 1
SHOWER STALL J is wi !I_________ ______, ,._.,.:, r 31
11
TOILET if �-li 9 l4 .1.11 11___ L IiI .___1r'1_- iL__._.__;______Jf I_1I -'(►______.II
IT
WASHING MACHINE CONNECTION • 11 111 ,lif �I &L g - -� - � - <�— I— i� I F _T.J '
1 _.�..WAt? HEATER ALLTYPES 1r gLjI ` F( i�. Il V tl! _,_._ 1 i I=lWATEP PIPING - — .`
r' J II s
I OTHERI --T _ 7z` `j �(_ III I - =1 _ __ is I�( ______A ;� __-__�: _ �'� l
-- - __ ,. ._�_t__— _ ._ f WI •i :4___. I : ��i ( 11_—._ 1_ zU �:.0 1__-___i�
�C F� i1__� - �l
------- ___�:1 j _mil_�1______�I. =iii 1 -
I - T _'!_-._.____ IT - - iii =I i d__t k- -
- INSURANCE=IMAGE _.:...
I Iievq a curentliability insurance policy br its substantial equivalent which masts the raqutrements o rtfiGL CA.--vp.. YEErerNO El
IF YOU CHECKED Y2r PLEASE INDICATETHETi'PEDFCOV; ,AGE BYCI�ECKING THE APPROPRIATE BOX SELn 1 r,LJV 7 2t
UA81U i Y fi•ISIJRAI~ICEPOLICY �f— - - ,
• OTHER OF INDEMNITY BOND
- - BUILDING GLPf1Mcl rvit:N •
r
• OWNER'S INSURANCE WAIVER:I am aware that the licensee does not Dave la insurance coverage required =18 . • ""- 2.-2 ----
• _Massachusetts General Lams,and that my signature on this per„it application waives this requirement. -
•
SIGNATURE OF OWNER ORA�II�I T - CHECK ONE ONLY: OWNER 0 AGEi�
-
I hereby certify that ail of the des and information I have subnuTed orenterad
stgyatilin,g Misapplication are Eros and accurate to msDt of my lmrnrJleagr
end that all plwttbina mit acid installations peJ ormsd under the permit issued forihis application v.,111 be in c mpliarr ewith all Periinentp avision of the
illaseachusel .s Siete Plumbing Code and Chapter 742 cf the General Laws. o
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PLUMBER'S NAME r r,g -i2 U d 1 LICENSE ?$9' 1 - SIGN�ti RI (/
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