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HomeMy WebLinkAboutP-19-1732 �.. c 50 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ._,. ..1__—.,,c n c `F1_ C CITY Yarmouth MA DATE 09.17.18 PERMIT# SAP-5-00 tin JOBSITE ADDRESS 5 Franklin St Yarmouth OWNER'S NAME Scott McKenzie POWNER ADDRESS 284 ThompsonHIII Rd Thompson CT TEL 508-648-1559 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL Q RESIDENTIAL I PRINT CLEARLY NEW:® RENOVATION.© REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO© FIXTURES? FLOOR-. I BEM 1 ' 2 3 4 5 6 7 8 9 ' 10 11 12 13 14 CROSS CONNECTION DEVICE - i . I ii DEDICATED SPECIAL WASTE SYSTEM 'r ' - t •- 'MOS- DEDICATED GAS/OIL/SAND SYSTEMa I , _ �iw DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ .1 fi I I DEDICATED WATER RECYCLE SYSTEM , . . fll ilaiS'if . 1 DISHWASHER DRINKING FOUNTAIN '�' FLOOR/AREA DRAIN .nam 1 FOOD DISPOSER IAMRL INTERCEPTOR(INTERIOR) lj r—_ 1 ;; I —. ''.____. KITCHEN SINK _ ._ LAVATORY Wildu _ f ,� lirl � � ROOF DRAIN ._, �__ I _ '. - W SHOWER STALL ' '� W SERVICE/MOP SINK I ,( I -- TOILET URINAL 1 WASHING MACHINE CONNECTION WATER PIALL WATER PIPING TYPES f � IL . , OTHER PING i y r- 4. I_ INSURANCE COVERAGE:�, I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES DI NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY O 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 perrnit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT Q SIGNATURE OF OWNER OR AGENT 1 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 mpliance with all Pertinent provisi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /'1 ' PLUMBER'S NAME Craig Bishop LICENSE#115101 S� SIGNATURE • MPD JPQ CORPORATION 0# 'iPARTNERSHIPD# ' ILC # : COMPANY NAME High Efficiency ADDRESS 378 Route 130 CIN Sandwich 'STATE ijn ZIP 02563 ' TEL 508-825-3695 FAX 1 CELL EMAIL admin@high-efficiencyllc.com 1 Le* t tefrAgc /A-6 c ye //iii /0( 7y-