HomeMy WebLinkAboutP-18-6083 —Th MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
wig CITY Yarmouth MA DATE 4/27118 PERMIT# Pig'Cd�$,
JOBSITE ADDRESS 82 Higgins Crowell Road OWNER'S NAME Legatowicz
P OWNER ADDRESS do Oceanside Restoration TEL 508-771-3110 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIALD
PRINT
CLEARLY NEW:❑ RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑
FIXTURES 1 FLOORS BSM1 2 3 4 5 6 7 • 8 9 10 11 12 13 14
BATHTUB ' t I 1 • I
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM j
DEDICATED GAS/OIUSAND SYSTEM ! r— ,
DEDICATED GREASE SYSTEM 1
- -
DEDICATED GRAY WATER SYSTEM r e+ 1 f
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER 1
DRINKING FOUNTAIN - r, - i - - r
FOOD DISPOSER _ i [
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) i
KITCHEN SINK 1
LAVATORY 2- "r
ROOF DRAIN l
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 2' j H a f i 'i' ) \ 1= l
URINAL I i 1 1 rr -
WASHING MACHINE CONNECTION 1 1•• I
WATER HEATER ALL TYPES r t ' .1 I I I
WATER PIPING 1 7 T '
OTHER ' a Ji i_ NU l EPA IMF,ill-
1 11 1 I I 1 I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY D 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 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 . I Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Jr. r
PLUMBER'S NAME Stephen D.Ewing LICENSE# 15281 rr---SIGNATURE
MPD JP[3 CORPORATIOND# 3672 PARTNERSHIP❑# .LLC❑#
COMPANY NAME Edgewater Plumbing&Heating ADDRESS P.O.Box 656
CITY Sagamore STATE MA ZIP 02561 TEL 508-317-9680
FAX CELL 508-737-0077 EMAIL stever(7edgewaterplumbinginc.com
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