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HomeMy WebLinkAboutBLDP-19-002506 MASSACHUSETTS UNIFORM APPLICA 1A i�A PERMIT TO PERFORM PLUMBING WORK I. Via= II 31 CITYIYARMOUTH //U/F I, TE 10/23/18 PERMIT#t) OP7? 60JSt JOBSITE ADDRESS 2 PAYNE ROAD OWNER'S NAME I MORRISON P OWNER ADDRESS: SOUTH YARMOUTH I TEL: FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO 0 FIXUTRES 1 FLOORS-4 Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑t OTHER TYPE INDEMNITY 0 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 0 AGENT 0 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 applica'on will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /� S /I I, C� PLUMBER NAME: LEON E CLARK,JR. LICENSE# 11734-M ISIGNATURREcCOMPANY NAME: I TC TYNDALL 8 CLARK PLUMBING AND HEATING I ADDRESS: 18 ATLANTIC AVENUE CITY:I SOUTH DENNIS STATE: MA ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1452 EMAIL karen@tcplumbing.net MASTER 0 JOURNEYMAN❑ CORPORATION❑I # PARTNERSHIP❑# _ LLC 0 tit/4- JAL � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'VW CITY YARMOUTH MA. DATE 10123118 PERMIT#Age-fir-02a5-0 JOBSITE ADDRESS 2 PAYNE ROAD OWNER'S NAME MORRISON GOWNER ADDRESS: SOUTH YARMOUTH I TEL: FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 NO 0 FIXUTRES 7 FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑] OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 appli on will be in compl' nce with all GPertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ( e (� rlz — PLUMBERIGASFITTER NAME: LEON E CLARK,JR. LICENSE# 11734-M SIGNATURE COMPANY NAME: (TC TYNDALL&CLARK PLUMBING AND HEATING 1 ADDRESS:118 ATLANTIC AVENUE CITY: I SOUTH DENNIS STATE: MA ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1452 EMAIL: Karen@tcplumbing.net MASTER 0 JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0# PARTNERSHIP❑# LLC❑# n Gn if- I Foe o7c °kit /0 /(-7/f