HomeMy WebLinkAboutBLDP-19-002947 j- �
e • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
.1= Ic
`;Ye ; CITY Yarmouth Port MA DATE 11/8/2018 PERMIT#ELOn J7-CV;/797
JOBSITE ADDRESS 168 White Rock Road , OWNER'S NAME Chris Hughes
POWNER ADDRESS same TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL 0 RESIDENTIAL DI
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 • PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I . - I 1
CROSS CONNECTION DEVICE 1
DEDICATED SPECIAL WASTE SYSTEM I, )
DEDICATED GAS/OIUSANDSYSTEM _ , ___.I_-_
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM - ,
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER _ '
DRINKING FOUNTAIN
FOOD DISPOSER ,I ; _
FLOOR/AREA DRAIN ; _ i
INTERCEPTOR(INTERIOR) _ _
KITCHEN SINK �,
LAVATORY I
i. '
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET F E. ,I� - -- (_- -
URINAL I
WASHING MACHINE CONNECTION ,,
WATER HEATER ALL TYPES
WATER PIPING I
II II ,; .
OTHER I__ -� LDI v6 i:i,
- -��s%�'-- .
- .
( � - I
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
UABIUTY INSURANCE POLICY Q 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 ❑
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. /-tc2 n- -
ee
PLUMBER'S NAME Tyque S Reed LICENSE# 15200 f7Y SIGNATUREG
MPO JP CORPORATION 0# PARTNERSHIP❑# LLCQ# 4047C
COMPANY NAME Coastal Mechanical ADDRESS 299 Whites Path 1
CITY South Yarmouth STATE MA ZIP 02664 TEL 5058-737-8747
FAX 508-760-5800 CELL 508-246-9959 EMAIL Tisa@coastalphc.com
Q?H440
�0J/1 -Jct