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HomeMy WebLinkAboutBLDP-23-004110 R MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -,-r CITY YARMOUTH MA DATE 1/25/23 PERMIT# BLDP 23 004110 I' JOBSITE ADDRESS 40 GRANDVIEW DR OWNERS NAME Kevin Manzolini P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 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/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 2 ROOF DRAIN SHOWER STALL 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Chris Poire LICENSE 38901 SIGNATURE MP ❑ JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS 37 Calvin Drive CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber@gmail.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 APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK E IC�� ,,(� MA DATE � � PERMIT# Z - L1//0 LT-1Md� �T' JOBSITE DRESS 7U G ul.v eUJ f OWNER'S NAME S -hAN 2 4� �I s.9 �3� 0 5',Z FAX DRESS ��a' • -.. . � TEL � a�� [� i• 34 YibEt tiolku 1-'8,66 ICY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT — — CLEARLY NEW:0 RENOVATION: PLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-* 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM • DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY oL • _ _ ROOF DRAIN _ SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL . WASHING MACHINE CONNECTION / WATER HEATER ALL TYPES WATER PIPING X, OTHER 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 0 • OWNER'S IN NCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass General Laws,a that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT ['f SIGNA OF OWNER OR AGENT-- L:I I hereby certify that all of the details and information I have submItted or entered regarding this application a 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 plian with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ( ,iv- 5 PC LICENSE# Pt 3 3 01 NATURE MP❑ JP CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME P°'rz - ' ADDRESS 50-+ 76PJ.t- sr CITY il-AtMit 1 STATE/1' ZIP d ° 1 TEL ) (( 03C (oc(V, FAX CELL ( - ( EMAIL �/'/`ni5�fold Q� l�t� c. I.r 0�. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FI PE NAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES