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HomeMy WebLinkAboutBLDP-23-004248 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1, CITY YARMOUTH MA DATE 1/31/23 PERMIT# BLDP 23 004248 I' JOBSITE ADDRESS 10 GEORGETOWN LANDING OWNER'S NAME ANDREADIS THEODORE GEORGE P OWNER ADDRESS MCMANUS MARGARET 306 GREENBRIAR DR CHESHIRE,CT 06410 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES z FLOORS BSM 1 2 3 4 , 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 3 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 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 0 NO El 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 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. 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 Virgilio Silva LICENSE X1395 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga@hotmail.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK � IIn' • I MA DATE 31/31/23 PERMIT# "2-')— L/ Z �JP �'t���" 10 Georgetown Landing JAti JOBS!'jjE-A S' g OWNERSNAMEIJ / Q,i 1s e % _OWNLW DD E . 10 Georgetown Landing TEL FAX 8. COING r� T - 0 PE COMMERCIAL El EDUCATIONAL El RESIDENTIAL El PRINT CLEARLY NEW: a, -ENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NOEl FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE ' i DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM - If f DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ! u DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL 11 WASHING MACHINE CONNECTION 1WATER HEATER ALL TYPES �III WATER PIPING 0 I__ I OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Ei NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 El AGENT El 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 Virgilio Silva LICENSE# 31395-J SIGNATURE MP Q JP El CORPORATION®# PARTNERSHIP El# I LLC El# j COMPANY NAME'Silva Plumbing&Heating ADDRESS 155 Sudbury Lane CITY Hyannis STATE MA ZIP 02601 TEL FAX ' CELL 774-836-0176 EMAIL rirgiliomga@hotmail.com