HomeMy WebLinkAboutP-14-332 -...,, MASSACHUSE TTS UNIFORM APPLICA1 ION FOR A PERMIT TO PERFORM PLUMBING WORK
• lieq th) CITY Yarmouth MA DATE 1111p PERMIT # 19 `t=332
JOBSITE 17 Bass River Road M# 70 P# 99 OWNER'S NAME Pazakis
POWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL
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CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO❑
FIXTURES-. FLOORt 1 2 J 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE ( '
DEDICATED SPECIAL WASTE SYSTEM
-DEDICATED GAS/OIDSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKINd FOUNTAIN ` V E L1
FOOD DISPOSER Rt. E
FLOOR/AREA DRAIN �MI
INTER/11-'10R (INTERIOR) t 'call
KI i CHEN SINK
LAVATORY illiiQI
NG pEP I• _ I
RAIt '
-SHOWER"STALL r'
SERVICE I MOP SINK _
TOILET
URINAL
WASHING MACHINE CONNECTION
-WATER IEATER-ALMI ES )
WATER PIPING
OTHER
INS HANLt CU%bNAGE: q�q4'GFA
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Clf'142 449 a NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW -
LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 1 f 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 mfomiabon I have submitted or entered regarding this application are true a • .cc -alleo my ow-•ge an
that all plumbing work and installations performed under the permit issued for this application will be in complian•- ith = vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General taws. T-
PLUMBER'S NAME James Pazakis LICENSE#PL-1503 'IGNATURE`.
MP ® JP El CORPORATION ®#C-2803 P R IP ❑# LLC ❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. ADDRESS:447 Old Chatham Road
CITY:South Dennis STATE:MA ZIP:02660 TEL 508-385-9127
FAX 508-385-6604 CELL EMAIL Halltechnician@comcastnet
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: E PERMIT#
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