HomeMy WebLinkAboutBLDP-16-007155 /0 -101'0
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
acs;le CITY South Yarmouth MA DATE 06127/2016 PERMIT# /1-0-'k4'7/b'
JOBSITE ADDRESS 11 Carol Road OWNER'S NAME Cody Farrier
P OWNER ADDRESS 11 Carol Road TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL D
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑+
FIXTURES 7 FLOOR-, BSM 11 J 2 3 4 5 6 7 8 9 10 1 11 12 13 14
BATHTUBI I
-dam.-
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM I _ I
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
i- -r-
DEDICATED GRAY WATER SYSTEM i i ,
DEDICATED WATER RECYCLE SYSTEM r i -�
DISHWASHER
DRINKING FOUNTAIN r- 7 - 1'r _ - r
I
FOOD DISPOSER I 1
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) i I_ - ,
KITCHEN SINK
LAVATORY
ROOF DRAIN ,_
SHOWER STALL -- r -' r -.If_ -- r -r -
SERVICE IMOP SINK 1
TOILET -
URINALr ' --r f
- - -
-r -
WASHING MACHINE CONNECTION1
WATER HEATER ALL TYPES
WATER PIPING 1I .:i - II
OTHER Ice Maker Connection - I
_ter . r
-r -
I 1 I
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
LIABILITY INSURANCE POLICY❑� OTHER TYPE OF INDEMNITY ❑ 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: • NER ❑ 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 a - ate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be IFall Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,�
PLUMBER'S NAME Phillip Durfee LICENSE# 13774 SIG -
MPQ JP CORPORATION 0# PARTNER P❑# LLC❑+ # 3152
COMPANY NAME Durfee Plumbing&Healing LLC ADDRESS 2A Huntington Ave.
CITY South Yarmouth I STATE MA ZIP 02664 TEL 508-619-3078
FAX 508.258.0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;joy@durfeeplumbing.com
-70 tel` 1-f
. .- Leff pLG , ou u2ftf..
• ' gi g
F,C;u"h -cr Lig/II 7�7//b