HomeMy WebLinkAboutBLDP-23-006079• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
c,; CITY YARMOUTH MA DATE 514123 PERMIT# BLDP-23-006079
r1= JOBSITE ADDRESS 507 NORTH DENNIS RD OWNER'S NAME NOVAK MITCHELL S
rD OWNER ADDRESS CAMPBELL-NOVAK JEANNE 507 N DENNIS RD YARMOUTH PORT,MA TEL
i 02675-2144
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO 0
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❑ NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE 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.
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 Joseph Rausa LICENSE 18445 SIGNATURE
MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME JOSEPH A RAUSA ADDRESS 10 SANTO ST
CITY IPLYMOUTH STATE MA ZIP 023605250 TEL
FAX -I CELL EMAIL nebathspermits@longhp.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
.10
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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u r CITY Yarmouth _ ., ( MA DATE 4/28/23 PERMIT # t/la--23 D06 t 7,1,1
JOBSITE ADDRESS 1507 N. Dennis Rd Yarmouth Port MA 02675 I OWNERS NAME Jeanne Novak 1
P
OWNER ADDRESS 1 507 N. Dennis Rd Yarmouth Port MA 02675 ! TEL 05 8-398-2489 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL v '
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: , PLANS SUBMITTED: YES EJ NOD
J
FIXTURES -1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 -
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
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DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM -
DEDICATED GRAY WATER SYSTEMA
DEDICATED WATER RECYCLE SYSTEM ! -
DISHWASHER _ �,.., .;p: —�-- ,_
_
DRINKING FOUNTAIN ____ _ . ----_. ---�. -`
FOOD DISPOSER
�-�
FLOOR / AREA DRAIN ._
INTERCEPTOR (INTERIOR) -- . 8
KITCHEN SINK
LAVATORY _ ---
ROOF DRAIN _ _ __
SHOWER STALL L.... - 1 __l .�,... _.�.. i
SERVICE l MOP SINK L ._ ,,� . I
TOILET _ ,—.. .:.I .._. ,�'`'
URINAL it 1l ...._„i R E F ! V E
13 1
WASHING MACHINE CONNECTIONS 1---- t 1
1
WATER HEATER ALL TYPES L 1 '
WATER PIPING _ j.,._,.... [ HAY 04
OTHER
:-._..___._.fit
�...
13UiL71NG MFPARTML"NT
....4 _.._.. _ ily - -- --
INSURANCE COVERAGE:
I have a current Iiability_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 INSURANCE POLICY , OTHER TYPE C F 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 PI Jmbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Joseph Rausa , _ J LICENSE # 1 445 "a------ ---s--S-.IGNATURE
MP - JP CORPORATION ETP #
#1 PARTNERSHIP' 14- LLC I# 4583
COMPANY NAME Lon Baths LLC I ADDRESS 300 Myles Standish Blvd I
CITY Taunton ISTATE MA I ZIP 02780 1 TEL 339-333-6118 1
FAX 1 CELL ,,7-244-0576 1 EMAIL nebathspermits@longhp,com _ K _
I