Loading...
HomeMy WebLinkAboutBLDP-23-004956 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 3/9/23 PERMIT# BLDP-23-004956 I I4 JOBSITE ADDRESS 128 CENTER ST OWNERS NAME WILSON MARK F TRS(LIFE EST) P OWNER ADDRESS WILSON PAULA R TRS(LIFE EST)128 CENTER STREET YARMOUTH PORT,MA TEL 02675-0000 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:© PLANS SUBMITTED: YES NO m FIXTURES _I 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 1 DRINKING FOUNTAIN FOOD DISPOSER - FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL - 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 m NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY m 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. 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 Albert Perry LICENSE 26791 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ALBERT J PERRY ADDRESS 10 HERON CIR CITY (MASHPEE STATE MA ZIP 026493418 TEL FAX CELL EMAIL ajpplumbingandheating@yahoo.com .nt ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ✓f} (3 4Po Q- ( MA DATE 3 g �j/�_ Z3-OP99�i6 RMIT# JOBSITE ADDRESS 1 g C N K ST. OWNER'S NAME AJ 7 K N ° c4 NL OWNER ADDRESS I Z S L( N7 L'(& S'. TEL <D S' 7 9oi 3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL' PRINT CLEARLY NEW:❑ RENOVATION:43 REPLACEMENT:ts PLANS SUBMITTED: YES© NO❑ FIXTURES 7 FLOOR—+ 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 r DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER C • DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN _ _ INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY ROOF DRAIN SHOWER STALL RECEIVED SERVICE/MOP SINK _ -- TOILET • URINALfMARnSi2 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ,,4cGTENT • 3ui�awc WATER PIPING OTHER _ INSURANCE COVERAGE: { I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES lel NO 0 IF YOU CHECKED YES,PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY l 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 aptalication waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 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 in compliance ' Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. " PLUMBER'S NAME LICENSE#2,67?f . SIGNATURE MP❑ JP 55 CORPORATION®# PARTNERSHIP❑.# LLC 0# COMPANY NAME AC PC'-Y Po./A-s"N G-T tI t ?NG ADDRESS I D y(Y2c7 N C r 4 C L e CITY (11 4S PCB STATE M'Q. ZIP O�`t' TEL "GP ' 41,1 7-cr FAX CELL 64) cif i EMAIL fo Pi V A 13(f) 436.4cA I'Jeu'fief f� ✓ yahoo , co r1 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