HomeMy WebLinkAboutP-19-2798 J13116 $50.00
:a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 10/30/18 PERMIT#840/1 9—ann
JOBSITE ADDRESS 187 UNION ST OWNER'S NAME LUISE SPEAKMAN
P OWNER ADDRESS SAME TEL 508-280-3562 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES D NOD
FIXTURES 1 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
DEDICATED GAS/OIL/SAND SYSTEM of
CROSS CONNECTION DEVICE �� f
lai
Si
DEDICATED SPECIAL WASTE SYSTEM � � — cDEDICATED GREASE SYSTEM
I
DEDICATED GRAY WATER SYSTEM A `�M
DEDICATED WATER RECYCLE SYSTEM 7
DISHWASHER ii r F I
DRINKING FOUNTAIN
FOOD DISPOSER / VLIIAt
FLOOR/AREA DRAIN i i
INTERCEPTOR(INTERIOR)
KITCHEN SINK k �`
LAVATORY rJ .f,1®fl—� I all
ROOF DRAINSell 001lit A
SHOWER STALL k
SERVICE/MOP SINK 6.
TOILETTOILET n
SIMS rilnAlliali 7
URINAL Mall.
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WASHING MACHINE CONNECTION d
jl
WATER HEATER ALL TYPES i ► - '
WATER PIPING all 'Ell,
OTHER �.
1 i r ,E
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
- UABIUTY INSURANCE POUCY❑' OTHER TYPE OF INDEMNITY D 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 ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this appli -Q.' are t e an• . urate to th- -est of my knovAedge
and that all plumbing work and installations performed under the permit issued for this application wil jail co p a• -with all Pertinent• .vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , --
PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 Ily SIGNATURE
MPD JP CORPORATION Q# 3969 PARTNERSHIP❑# LLC 0#
COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660
FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com ll klaube@callmurphys.com j
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: S PERMIT# 27/0 fLel
PLAN REVIEW NOTES
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