HomeMy WebLinkAboutBLDP-19-002101 a
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
t S 7t CITY South Yarmouth MA DATE 10/01/2018 PERMIT#440P79"0471/t/I
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JOBSITE ADDRESS 52 Country Club Drive OWNER'S NAME Megan Anthony '
POWNER ADDRESS same TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _ 11_11� _ _ —r —r ..r -r i
CROSS CONNECTION DEVICE II_ I
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM � a _
DEDICATED GREASE SYSTEM _ ;I . '
DEDICATED GRAY WATER SYSTEM i Q i.
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER L _ 1 _
DRINKING FOUNTAIN
FOOD DISPOSER i I 1 ,
FLOOR/AREA DRAIN 1 1
INTERCEPTOR(INTERIOR)
KITCHEN SINK , I
LAVATORY ,i . . _
ROOF DRAIN 1 I L
SHOWER STALL ~,1
SERVICE/MOP SINK
TOILET L.
URINAL
WASHING MACHINE CONNECTION (�_
WATER HEATER ALL TYPES 1 ,
WATER PIPING _ „ _ -
OTHER F d
Ir - - r r I - T
_ J .i I i 6 it I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q 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 ❑ 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. — 3 Mai
PLUMBER'S NAME Tyque S Reed LICENSE# 15200 �OOa"pua SIGNATURE
MPD JP❑ CORPORATION❑# 1PARTNERSHIP❑# LLC❑+ # 4047C
COMPANY NAME Coastal Mechanical ADDRESS 299 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747
FAX 508-760-5800 CELL 508-246-9959 EMAIL lisa@coastalphc.com
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