HomeMy WebLinkAboutBLDP-18-006073 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
GN1sr CITY Yarmouth MA DATE 4/27/18 PERMIT#nice/9—ovgo 75
JOBSITE ADDRESS 36 Channel Point Road I OWNER'S NAME Norm Peters
POWNER ADDRESS do Peter Moulton Construction TEL 508-385-8330 FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:Q REPLACEMENT:❑+ PLANS SUBMITTED: YES 0 NOD
FIXTURES 7 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUBna
CROSS CONNECTION DEVICE NM_M1111111111-111111111,
;_ ,_,MI MIsM MIN NM Ii a l�
DEDICATED SPECIAL WASTE SYSTEM _,_i�,i�,�„�„�,
DEDICATED GAS/OIL/SAND SYSTEM MIK SIM�,or♦;_flfl.1.;�
DEDICATED GREASE SYSTEM _,_,_,a,_,MEM a a a,_,_,a,_
DEDICATED GRAY WATER SYSTEM �f ����i�',�„�'®SaralIMis,lIMr_r_
DEDICATED ATERRECYCLESYSTEM aim==iaas�i��
DISHWASHER _—ira MI INI
ININ
DRINKING FOUNTAIN .,a„_,Car a,,ata;._S„_;_,a arae
FOOD DISPOSER _ i_�_I__L_i_.__,_San,a
FLOOR/AREA DRAIN __SEM_,___MEI=_S:_,__s
INTERCEPTOR INTERIOR _SS aTSanlaan ariP__
KITCHEN SINK Minn all i`�Mimi ma ma la soll MINI__,_i_Mil
LAVATORY Itilr®tarl i�if rin asj_ra1UitSr0
ROOF DRAIN _MIK=Man,_Mill manMos I_i_'ii_
SHOWER STALL a'®ra',aIala]anSa INESslal
SERVICE/MOP SINK MI SI_;,_S;SSIMS la_aa
TOILET aQ,aaaaaaa[tler n spa
URINALIISas an s,iseaa ra
WASHING MACHINE CONNECTION _;S[_llmtI_,i_r_f_;_laiiallosj_* *a
WATER HEATER ALL TYPES 0_11111111__ a 1111.1 MEM aa ]jwna
WATER PIPING maim r�i %a1riiliniiiSLUtaillitilkillitin
OTHER motaiNta._ia1assNS*a. i6rti1Ji a
aaai_a®_sallaistalaia__ai_ra__s__
�:®m_
S��isislr�1snsi�miM��1
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
LIABIUTY INSURANCE POLICY❑+ OTHER TYPE OF INDEMNITY ❑ BOND❑
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 ❑
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 -II Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Stephen D.Ewing LICENSE# 15281 SIGNATURE
MPD JP CORPORATION O# 3672 PARTNERSHIP D# LLC❑# J
COMPANY NAME Edgewater Plumbing&Heating ADDRESS P.O.Box 656
CITY Sagamore STATE MA ZIP 02561 TEL 508-317-9680
FAX CELL 508-737-0077 EMAIL steve@edgewaterplumbinginc.com
4-4e H-- -$10
itC1-2
--77o rd s9y