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HomeMy WebLinkAboutBLDP-21-002061 #148 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/19/20 PERMIT# BLDP-21-002061 _ n '' JOBSITE ADDRESS 579 BUCK ISLAND RD OWNERS NAME TURINO ASSOCIATES LLC P OWNER ADDRESS 2000 COMMONWEALTH AVE AUBURNDALE,MA 02466 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES t FLOORS-0 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 Ralph Giangregorio LICENSE 9639 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME RALPH J GIANGREGORIO ADDRESS 188 Route 28 CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL EMAIL office@3gsplumbing.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT El ❑ FEES$ PERMIT# PLAN REVIEW NOTES ivl A-P pca- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r. , C1lYt,0es-1- N MA DATE a-as-?oao PERMIT#abP-21-eezu40i JOBSITE ADDRESS 57 i►icix..1.s Idol 1 W OWNER'S NAME d � p OWNER ADDRESS 7c7 (1A. isk-d I I CI TEL Sok 7q0cWo FAK TYPE OR OCCUPANCY TYPE COMMERCIAL a— EDUCATIONAL 0 RESIDENTIAL 0 PRINT • CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:8- PLANS SUBMITTED: YES❑ NC FIXTURES Z FLOOR-. BSM i 2 3 4 5 8 7 8 e to 11 12 is 14 BATHTUB _ _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 1 DEDICATED GASIOIUSAND SYSTEM , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM . DEDICATED WATER RECYCLESYSTEM - DISHWASHER 1 _DRINKING FOUNTAIN - FOOD DISPOSER _ FLOOR/AREA DRAIN _ INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL > . SERVICE t MOP SINK F TOILET , r _- i URINAL • S WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 3__ W WATER PIPING A ,_ OTHER - 1 I - NCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES �10 0 IF YOU CHECKED YES,PLEASE INDICATE TH5TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that ail of the details and intonation I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work end installations perfomed under the permit issued for this appltcattonme be in nee with all Pert nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME P,A.A k C'` �' • -' . . E (� "►��=� v ,u� LICENSE# �'t�3Q ��RE � MP;lg JP 0 CORPORATION El#fir?C PARTNERSHIP 0# LLC❑# COMPANY NAME'.(:S Pb ,;r,iO)h -,- 14 �1•,1rtg ADDRESS 1 iccs- / r1,, ci- CITY riPbin►s p -fi STATE1YIiPr 2.I C'Pto.3° TEL - ci " 301 FAX, In LL i CELL -- EMAIL a ;r.7(a)3toz;(04)0,16 .b f