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HomeMy WebLinkAboutBLDP-15-002457 V t I I. 31 6a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 2mil i.., ® •1= a CITY Yarmouth MA DATE Oct 29,2014 PERMIT# Lir-/6m-01a1/SJ JOBSITE ADDRESS 210 Kates Path OWNER'S NAME Mr.Kelly POWNER ADDRESS Same TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:Q • PLANS SUBMITTED: YES❑ NOD FIXTURES 7 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ,I °i 1 j I , II 11y I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM y t -' - -- DEDICATED GAS/OIL/SAND SYSTEM ;- ,r _r ,� i - - � DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM —as nimissit DEDICATED WATER RECYCLE SYSTEM i O„ DISHWASHER DRINKING FOUNTAINw I II FOOD DISPOSER in FLOOR(AREA DRAIN 1V . INKITERCE TOK INTERIOR I, LAVATORY I, �r . ROOF DRAIN I*I� SERVICE/MOP SINK r ,• E SHOWER STALL �', ._ 4. TOILET , 11 URINAL n WASHING MACHINE CONNECTION- ,1 l WATER HEATER A TYPES' _ f r 1 4TEURINAL PIPI / 1 1 r OTHER - `N �VU 1 1 .,..r u l e.uyr f I I I 'I r r _ I Ir .._. J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY© OTHER TYPE OF INDEMNITY ❑ BOND El 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 El AGENT El 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. PLUMBERS NAME William Heath LICENSE# 12021 SIGNATURE MPO JP❑ CORPORATION O# 3487C PARTNERSHIP❑# 3321C LLC 0# COMPANY NAME Murphys ADDRESS 34 Whites Path CITY South Yarmouth STATE Ma ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL Itetrault@callmurphys.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION.NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: S PERMIT# PLAN REVIEW NOTES 4 1