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Home My WebLink AboutBLDP-22-000580 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4. r ' CITY YARMOUTH MA DATE 8/2/21 PERMIT# BLDP-22-000580 if JOBSITE ADDRESS 106 CAPT YORK RD OWNER'S NAME CARVER ROBERT J P OWNER ADDRESS CARVER PAUL J 39 DUDLEY ST MARLBOROUGH,MA 01752-1816 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑ FIXTURFS ._. 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/OIUSAND 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 WATER PIPING OTHER 2 OTHER DESCRIPTION:ice maker w/water hammer arester INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 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. PLUMBER'S NAME Virgilio Silva LICENSE 3t1395 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN CITY HYANNIS STATE MA ZIP 026012462 TEL I 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 v=r� '`lm t' CITY Yarmouth MA DATE 38/02/21 PERMIT# 2Z-' 5- B 6 JOBSITE ADDRESS 106 Captain York Rd. OWNER'S NAME POWNER ADDRESS 106 Captain York Rd. TEL _ FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:® REPLACEMENT:0 PLANS SUBMITTED: YES Li NOEl FIXTURES Z FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB i I CROSS CONNECTION DEVICE _L- v _ .1 - DEDICATED SPECIAL WASTE SYSTEM ; DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM .. I DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN 1 1 I j_ FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY I . I -- .. I I ROOF DRAIN ( SHOWER STALL I SERVICE/MOP SINK I 1, , I 1 I TOILET URINAL I , I , WASHING MACHINE CONNECTION I, I ._ II I - i I 1. i - I WATER HEATER ALL TYPES WATER PIPING I I I OTHER fce maker 1 �� , 14/fUater hammer arrester 1 �. .. ' . 4 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO Ei IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY 0 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 0 AGENT Li 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 accu . • • 'est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn• '. with all Pertinent pro,' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Virgilio Silva 31395-J —`�� LICENSE# SIGNATURE MPL JP El CORPORATION®# PARTNERSHIP I# j LLCM# ,__.......E.4.— COMPANY NAME Silva Plumbing and Heating ADDRESS 155 Sudbury lane R E C E�15o CITY Hyannis STATE MA ZIP 02601 TEL A(((; 0 2V2021 ' FAX CELL 7748360176 EMAIL virgiliomga@hotmail.com fl OUILDING DHPARTMFNT CIO* 12tvCr