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Home My WebLink AboutBLDP-22-01243 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK p CITY YARMOUTH MA DATE 9/2/21 PERMIT# BLDP 22 001243 i' JOBSITE ADDRESS 248 CAMP ST UNIT C5 OWNERS NAME Avis Carter P OWNER ADDRESS 248 CAMP ST UNIT C5 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO 0 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/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 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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 Andrew Mikita LICENSE 18843 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME ANDREW J MIKITA ADDRESS 48 INTERVALE LN CITY S HARWICH STATE MA ZIP 02661 TEL FAX CELL EMAIL none ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES i r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -"'"- 4 CITY/TOWN /4Z1410 v%/V MA DATE 6-34,-a/ PERMIT# 'Li- 1 2 i3 <J JOBSITE ADDRESS �yg 637,P11 *5I "6.°', .7 OWNER'S NAME /4 V/.5 Crake/r POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL;KJ PRINT /' (� CLEARLY NEW: El RENOVATION: ❑ REPLACEMENT:l� PLANS SUBMITTED: YES El NO El Z 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ' WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantiaLequivalent which meets the requirements of Ch.142. YES El NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er 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. 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 co ' ,cr ll P rtinen provisi pf e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ANQ V S ` /y7//(1 > 4 LICENSE#/e64/.3 NATURE MP❑ JP[r CORPORATION # PARTNERSHIP❑# LLC❑# COMPANY NAME /MA./ //9 K•/7 ADDRESS ? ®• 3°X 5/8 CITY• /14l2cvl CN STATF12ZLL ZIP 47244/ TEL Sc -a31•- 5°leg FAX CELL EMAIL