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HomeMy WebLinkAboutBLDP-19-002432• '..- J13090 $50.00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ELS CITY YARMOUTH MA DATE 10112113 'PERMIT#//'WP79 OQO'V 4 li_ JOBSITE ADDRESS 53 POMPANO RD OWNER'S NAME MONIQUE CROWLEY • P OWNER ADDRESS SAME TEL 508-332-8618 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:© RENOVATION:❑ REPLACEMENT:p+ PLANS SUBMITTED: YES© NOEl FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB { 1 r it r r [ I I 1 CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM -- rn. -.!r -I - --in r rr r I „ 1 i , I 1. ai i i. DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM I i I I . DEDICATED WATER RECYCLE SYSTEM 1i DISHWASHER , I �1i I ir i DRINKING FOUNTAIN iai FOOD DISPOSER I FLOOR I AREA DRAIN , I EIINTEIIO TOR( R) igr ji; 44 I [ . [ I 1 ROOF DRAIN EF. F _. SHOWER STALL • I' SIR SERVICE 1 MOP SINK1 I ir- TOILET I i URINAL I WASHING MACHINE CONNECTION , I WATER HEATER ALL TYPES WATER PIPINGe� OTHER l i l , , a ., _i - i I I , r- r F--- 7r 7 --Ir ' , 1 , r it in 11 , ,r- INSURANCE rINSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW . LIABILITY INSURANCE POUCY p+ 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 El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati• an true .nd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b tie •p•'a - '-- t pr. ! ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Q n.. PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 6 SIGNATURE MPO JP CORPORATION0# 3969 PARTNERSHIP Q# LLC[]# COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com l/ klaube@callmurphys.com ;le ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 /J 7 ih,/ FEE: $ PERMIT# Z./-7/1?//- /////yjfrr. PLAN REVIEW NOTES