HomeMy WebLinkAboutBLDP-19-002580 t
• Si,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
_ _ CITY Yarmouth MA DATE 10I22I2018 PERMIT#/wJP/9
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JOBSITE ADDRESS 13 MacKenzie Rd. OWNER'S NAME Bryson I Colina
P i OWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL Q
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES 0 NO❑
FIXTURES 1 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB t
CROSS CONNECTION DEVICE
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DEDICATED SPECIAL WASTE SYSTEM I
DEDICATED GAS/OIIJSAND SYSTEM r
DEDICATED GREASE SYSTEM � � r
DEDICATED GRAY WATER SYSTEM i 1 t 4 11 t I I
DEDICATED WATER RECYCLE SYSTEM 1 I 0 1 1 =.___.II
DISHWASHER _
DRINKING FOUNTAIN 1
_
I
FOOD DISPOSER J (�
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) 7 r-
KITCHEN SINK1
LAVATORY _ r
ROOF DRAIN
SHOWER STALL =' w � _ i
SERVICE I MOP SINK
TOILET ' R'S RE A : iltilitio-gil
URINAL 1 _I _5 -- = - '
WWATTER PIPINGR ALL TYPESi
WASHING MACHINE CONNECTION
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13 ail I L.
OTHER - - _ r _�,ir
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 POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND Q
OWNER'S INSURANCE WAIVER:lam 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
1 hereby certify that all of the details and information I have submitted or entered regarding this application are t. :and accurate t.the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in 'ian s iJ� tp: ' •• - •-
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /j j/5
PLUMBER'S NAME Peter J.Hassett LICENSE# 11682 SIGNATURE
MP0 JP CORPORATION Q# 3506 PARTNERSHIP❑# tic 0#
COMPANY NAME Hassett Plumbing and Heating,Inc. ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555
FAX CELL 508-237-2175 EMAIL peterjhassett@gmail.com
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