Loading...
HomeMy WebLinkAboutBLDP-23-004266 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK k e CITY YARMOUTH MA DATE 2/1/23 PERMIT# BLDP-23-004266 JOBSITE ADDRESS 74 POND ST OWNER'S NAME TEIXEIRA MAURICIO P OWNER ADDRESS 74 POND ST SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 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 El NO 0 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. PLUMBER'S NAME Kesuqs Lopez LICENSE 1€301 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KESUQS LOPEZ ADDRESS 107 Meetinghouse Rd CITY Mashpee STATE MA ZIP 026492617 TEL FAX CELL EMAIL klopez2k11@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES • +Q,, SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' --cM O( '1 MA DATE //3 I/ 3 PERMIT* 31 iB2is 1 ASDRESS7u1 �t`)r�C.l St- t OW/NER'SS NAME►'IQl1Y'►CAO— C\XCi rq_ :uILD UEFA•=. or,. r DRESS / P ^ `- TEU )367—a30 FAX OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL 01 PRINT CLEARLY NEW:❑ RENOVATION:[) REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO[p FIXTURES 7 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 _ I_____ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM w DISHWASHER ' DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN - INTERCEPTOR(INTERIOR) T KITCHEN SINK I _ LAVATORY ROOF DRAIN SHOWER STALL I • SERVICE I MOP SINK _ TOILET I _ _ i URINAL , . I WASHING MACHINE CONNECTION I _ _ WATER HEATER ALL TYPES _ WATER PIPING OTHER _ . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESP NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 12t OTHER TYPE OF INDEMNITY 0 BOND 0 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 0 ,,, 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 compia with all provision of the Massachusetts State PI ing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEfreSUGl$. Z LICENSE# 16 30 i . SIGNATURE MP 1.'i JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME E 1-1 CO eP 1 bt J ADDRESS 41)7 CITY 116/11XC STATE OW1 ZIP CA119 TEL C 77 LI) . `76I FAX Id I a CELL(17q)(23B-Jt b EMAIL L6p7.z l t-si,O_Ly?vial • C v ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • • +,