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P-13-840
1 1--. , t,LiMASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ lin CITYI.SL fou Ki _ MA DATE Co 343 PERMIT# p/3- gni ,e= JOBSITE ADDRESS 3/ 41.4ffcas'& L✓ay OWNER'S NAME ,y,4104, S{n.— POWNERADDRESSI $a —'- I TEL C'31.,319. #s-6 y IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL © RESIDENTIAL["]� PRINT r CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:Ia9" PLANS SUBMITTED: YES 0 N09 FIXTURES 1 FLOOR–. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB r ate Ir.- - i _ ,Sia a CROSS CONNECTION DEVICE lillinla DEDICATED SPECIAL WASTE SYSTEM ( j r - I I I Ji I: l DEDICATED GAS/OIL/SAND SYSTEM i I DEDICATED GREASE SYSTEM L DEDICATED GRAY WATER SYSTEM I I DEDICATED WATER RECYCLE SYSTEMfl `r Ir— DISHWASHER r -! DRINKING FOUNTAIN M. ' F-- FOOD DISPOSER r- MI it _. FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) -I KITCHEN SINK1 = 1 I LAVATORY1. ll I ROOF DRAIN r , SHOWER STALL ESrSIS Mme2, = all SERVICE/MOP SINK . a an TOILET URINAL la 1EI 1I 2 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES r I 'J r WATER PIPING - OC___ OTHER — r -. Lu SMIA INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND Lj 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 Q 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 comp! .nce th =I •ertinent provIsion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. g�,� PLUMBER'S NAME Joseph Ventresca LICENSE# Can SIGNATURE MP El JP© CORPORATION O# 3255 ,PARTNERS PO# , LLC Q# COMPANY NAME South Shore Heating and Cooling ADDRESS 57 Whites Path CITY South Yarmouth STATE MA _ ZIP 02664 TEL 508-398-69B ' li? (3 Ir: it 11 k FAX 508-760-2681 CELL 508-360-5277 EMAIL joe@southshoreheatingcooling.com I` Il; _._ I /I- I1tit�iL ;' it �2 - UtlILDWGD - T v BY.--------, ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES • •