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HomeMy WebLinkAboutBLDP-23-006048 '— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/3/23 PERMIT# BLDP-23-006048 wn 7 al JOBSITE ADDRESS 47 NICKERSON FARM WAY OWNERS NAME CHRISTOPOULOS DANIEL P OWNER ADDRESS 27 MAKEPEACE LN WEST YARMOUTH 02673-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES Ea NO❑ FIXTURES z FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 1 CROSS CONNECTION DEVICE 1 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE _DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 3 1 ROOF DRAIN SHOWER STALL 2 SERVICE/MOP SINK 1 TOILET 2 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 WATER PIPING 1 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 m NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 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 BRADLEY TOMASETTI LICENSE 1€544 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME TOMASETTI PLUMBING ADDRESS 103 UNION ST CITY YARMOUTH PORT STATE MA ZIP 02675 TEL FAX CELL EMAIL tomasettiplumbing@gmail.com r a ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES 4 A . ...' MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORKrg1-4/ M P-Z3�oD�l CITY%� c,..- itx MA DATE .57Z/Z O Z-3 PE # JOBSITE ADDRESS y7 /2 zJr--SO•4 7 / / y OWNER'S NAME CL-n 1 l �„ ►,I bS' P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL V PRINT ^/ CLEARLY NEW:li' RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 6. 9 10 11 12 13 14 BATHTUB I I CROSS CONNECTION DEVICE t I DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN : FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY , '3 I - - . ROOF DRAIN , SHOWER STALL 2. . SERVICE 1 MOP SINK I E � � TOILET 2. / _ URINAL I WASHING MACHINE CONNECTION I M' 0 2 WATER HEATER ALL TYPES I WATER PIPING I, B I Cal k DJ ) - j OTHER _ 6y — _— ' try I �II INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 1NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY E 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 apQlication waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT l 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 inn with al •Rent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ----Th PLUMBER'S NAME 5-z.d 70-ei4 sew LICENSE#/4,5yy . SIGNATURE MP r]: JP❑ CORPORATION 0# PARTNERSHIP❑.# LLC 0# COMPANY NAME ih• s er / i C,- ADDRESS !Q U 3 ' t 5.- CITYy'— avg,/V7 STATE inZIP t 6 7.3— TEL FAX CELL 7Z 5 ZZ`1100 1 EMAIL. 21 '<; i;#91T,. . I. Cor, \6\ c0 lds a a 3 0 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 Y L