HomeMy WebLinkAboutBLDP-18-006143 612-0 A M PI akar
r✓ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
t' Til To'cn . CITY YARMOUTH MA DATE 5/2/2018 PERMIT#/gal-if'al C MI
• JOBSITE ADDRESS 99 LEWIS STREET OWNERS NAME MURPHY
P OWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL El
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUBi III
j
, CROSS CONNECTION DEVICE •
DEDICATED SPECIAL WASTE SYSTEM _ i
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM r
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN ��.
• FOOD DISPOSER a i
i i
FLOOR/AREA DRAIN IIII
INTERCEPTOR(INTERIOR)
KITCHEN SINK al .
LAVATORY n
RSHOWER STALL F DRAIN VI MM
1 ,�
SERVICE I MOP SINK
TOILET
URINAL 11111111111
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES _WATER _
OTHER r LNG MO t ,i wit- � ,
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INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q 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 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are two 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 c• anc, th •ertinent• • 'sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / 49. arm
PLUMBER'S NAME Peter J.Hassett LICENSE# 11682 1 IGNATURE
MPO JP❑ CORPORATION Q# 3506 PARTNERSHIP❑# LLC 0#
COMPANY NAME Hassett Plumbing and Heating,Inc. ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA ZIP 02675 TEL 508.744-7555
FAX CELL 508-237-2175 EMAIL JL. lr-. 3. — ' $7cbr-jJra.sse.t 3niiii_._Canr 1
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