HomeMy WebLinkAboutBLDP-19-000439 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
ny CITY Yarmouth I MA DATE 7/19/2018 PERMIT#/'0P/9-90070
JOBSITE ADDRESS 3218 Heatherwood,Yarmouth Port OWNER'S NAME Ulrich
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:0 RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑
FIXTURES 1 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 GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER Si — r 7 I i , I Tr
FLOOR I AREA DRAIN - r
INTERCEPTOR(INTERIOR ;r— r r r -
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KITCHEN SINK
LAVATORY �' i i I
ROOF DRAIN
SHOWER STALL 2 _ , I• L" — I'
SERVICE IMOP SINK j
TOILET 2
URINAL
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WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES t
WATER PIPING j i
OTHER —
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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 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
CHECK ONE ONLY: OWNER ❑ AGENT 0
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 Peter J.Hassett LICENSE II 11682 SIGNATURE
MPD JP CORPORATION Q# 3506 PARTNERSHIP❑# LLC❑#
COMPANY NAME Hassett Plumbing and Healing,Inc. ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA I ZIP 02675 I TEL 508-744-7555
FAX CELL 508-237-2175 EMAIL peterjhassett@gmail.com
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