HomeMy WebLinkAboutBLDP-19-001958 -t �� MASSA US US UNIFORM APPLICATION FOR A PERMIT PERFORM PLUMBING WORK
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,; CITY YARMOUTH MA DATE 9126118 PERMIT#/A1P X 9-00/TO 0
JOBSITE ADDRESS 15 ROSE ROAD OWNER'S NAME CHRIS LEGERE
P OWNER ADDRESS same TEL (774)353-7113 FAX—
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES 0 NOD
FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUBt
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CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM L„.,_„1 _,1IJ 1 _J L.._ I 1 l -
DEDICATED GASIOIUSAND SYSTEM + i i 1
DEDICATED GREASE SYSTEM j I
DEDICATED GRAY WATER SYSTEM .. , N „—I I
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DEDICATED WATER RECYCLE SYSTEM" '
DISHWASHER j
DRINKING FOUNTAIN — *
FOOD DISPOSER —'
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR) li, i k
KITCHEN SINK
LAVATORY i , ( y i
ROOF DRAIN 1
SHOWER STALL ,I °
SERVICE/MOP SINK IIlI
TOILET
URINAL i r ,
WASHING MACHINE CONNECTION r
WATER HEATER ALL TYPES 1 l
WATER PIPING ,II
OTHER I. , J 3
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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 9 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY 9 . 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 applica - e 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 P�,. ompliance with all Pert - t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .
PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 00 - SIGNATURE
MP0 JP E] CORPORATION0# 3969 PARTNERSHIP❑# LLC 0#
COMPANY NAME Murphy Services Inc 1 ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660
FAX 508-760-1670 CELL - EMAIL cshea@callmurphys.com Il klaube@callmurphys.com
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No _
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
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FEE: $ PERMIT#
PLAN REVIEW NOTES
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