HomeMy WebLinkAboutBLDP-19-002977 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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-9 CITY YARMOUTH MA DATE 11/14/18 PERMIT# BLDP-19-002977
JOBSITE ADDRESS 34 GINGERBREAD LN OWNER'S NAME LLDAUNTLESS PROPERTY MGT
P OWNER ADDRESS C/O ALAN C MILLER MANAGER 35 ORCHARD HILL RD NEWCINN, TEL
CT 06470
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 9
PRINT
CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
FIXTURES z FI DORS-. RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE 1
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTE
DISHWASHER "
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN •
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
• TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
WATER PIPING
OTHER
OTHER DESCRIPTION:
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 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 BOND 0
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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.
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.
PLUMBER'S NAME Walter Nye LICENSE 32083 I SIGNATURE
MP ❑ JP 9 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
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COMPANY NAME NYE PLUMBING&HEATING ADDRESS 349 Great Western Road
CITY Harwich STATE MA ZIP 02645 TEL r
FAX CELL EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 4
Yes No
-- --- - THIS APPLICATION SERVE AS THE ❑ ❑
O DMIT
FEES$ PERMIT#
PLAN REVIEW NOTES
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