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HomeMy WebLinkAboutBLDP-23-005321 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, CITY YARMOUTH MA DATE 3/28/23 PERMIT# BLDP-23-005321 t l JOBSITE ADDRESS 166 BAYVIEW ST OWNER'S NAME FACCHINI ANTHONY P P OWNER ADDRESS FACCHINI D R&FACCHINI R A JR 519 PROSPECT ST EAST LONGMEADOW,MA TEL 01028 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW: 0 RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO❑ FIXTURFS ..1 FLOORS--0 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 2 SERVICE/MOP SINK c 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❑ NO ❑ 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 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. PLUMBER'S NAME Mike Phommasing LICENSE V#415 SIGNATURE MP 0 JP © CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS CITY STATE ZIP TEL FAX CELL EMAIL phommasingmike@gmail.com r 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 _ ' ir ��= CITY 4�-C>S"� ' IAA V MA DATE 3 f 2� �2� PERMIT* Z3- S 3 z j JOBSITE ADDRESS If0(P 8a I1 1/(,e(t) S'T OWNER'S NAME 1)Gvll-1(1 ILI CZ 17 i yr t' POWNER ADDRESS C - --d2— 7 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTLa>lin' PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT? PLANS SUBMITTED: YES 0 NO 0 FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 B' 9 10 11 12 13 14 BATHTUB / _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER DRINKING FOUNTAIN _ _ FOOD DISPOSER T FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN _ SHOWER STALL SERVICE 1 MOP SINK _ R E C E D . TOILET URINAL . WASHING MACHINE CONNECTION MAli 2t 2023 WATER HEATER ALL TYPES WATER PIPING gin DING DE DARTLr TENT OTHER eyr s__ - INSURANCE COVERAGE: { I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES, NO 0 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 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. • CHECK ONE ONLY: OWNER ❑ AGENT 0 Z SIGNATURE OF OWNER OR AGENT L:I 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 P aeRt previsIon of the Massachusetts State Plumbing C de and Chapter 142 of the General Laws. PLUMBER'S NAME MIlie 1446 P"PIA. S Ikl) LICENSE#3yLi/r. SIGNATURE MP❑ JP5a. CORPORATION 0# PARTNERSHIP D# / , L`J)LC 0# COMPANY NAME flit flULht*i 1( s,4-1,�4 uS ADDRESS � /1-m y -/�e4/ CITY DV-c c-u STATE jMk ZIP 01 2 TEL FAX CELL 1)-(5 ,5,5(96 I &Of EMAIL h0/411u4 Jl 114 '`C. - re PI C �I h7U �. 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