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HomeMy WebLinkAboutBLDP-22-006694 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �, CITY YARMOUTH MA DATE 5/19/22 PERMIT# BLDP-22-006694 JOBSITE ADDRESS 1 BRUSH HILL RD OWNER'S NAME Marcilio Lopes P OWNER ADDRESS 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES • FLOORS-I 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 1 ROOF DRAIN _ SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER _ WATER PIPING OTHER 1 OTHER DESCRIPTION:sewage ejector 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❑ 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 Hayes LICENSE 16489 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME PLUMBING SOLUTION BY HAYES ADDRESS 22 Rustic Lane CITY Hyannis STATE MA ZIP 02601 TEL FAX CELL 7747225013 EMAIL PLUMB_HAYES91@YAHOO.COM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT N PLAN REVIEW NOTES ._._ /0. Db __ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK R E is__ _ - _ a ITY P.(A t Qocf� MA DATE 5114�2Z PERMIT# '1 ��O9h ,AY 1 0 2022 J BSITE ADDRESS G 13rrOS1eN WillP be L OWNER'S NAME I rc tL d Lo�¢ _._: �WtiER ADDRESS l 13C UM" lei l I (ZaotvL TEL. 7y- 3[/- 3 3 9 a- FAX BUILDING CARTMENT • BY` -eCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Le PRINT � CLEARLY NEW:d RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO["1/ 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/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 I SERVICE/MOP SINK TOILET 1 URINAL . j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER St..,1°t (u- � 4er Qt7MI) II . , II J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES d NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Jf 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 t Massachusetts General Laws,and that my signature on this permit application waives this requirement. 1� CHECK ONE ONLY: OWNER 0 AGENT 0 Z SIGNATURE OF OWNER OR AGENT L'J I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a urate 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 ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 4-nd,'ri„) `-calls' LICENSE#Ili 1 1 , SIGNATURE MP[ JP❑ CORPORATION 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME f iUwrb nqJ salcrha„,i ,(� Par ADDRESS 22. LUSi-;c. LavP- CITY ado►t-n; s STATE NIA- ZIP 0a-4a ( TEL FAX CELL l q- 1 Zz - 5t 0 EMAIL p toM6 tilt Li qlC►gQ11b>a.GBM ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES 1