HomeMy WebLinkAboutP-13-581 ILS -" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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W/ cry bxgt-tin(AA1V MA DATE I0H`I3 PERMIT# 09—
JOBSITEADDRESS I 19 1 ('ak.,,SyfAtI Q 4. 1 OWNER'SNAME C3al,rti I Migat
P OWNER ADDRESS L ®isi TEL in. a,K. 37.FAX •w
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL I
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:E PLANS SUBMITTED: YES 0 NOD
FIXTURES 7 FLOOR-) 63M 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _
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CROSS CONNECTION DEVICE IONWIltiail......11.110111101.1,,S9SMInta
DEDICATED SPECIAL WASTE SYSTEM Mil -I 1 MS 1111 _ Ill 1 I te
DEDICATED GAS/OILISAND
DEDICATED GREASE SYSTEM 7 11 11 In— MI 11 nnr—i[ T '
DEDICATED GRAY WATER SYSTEM 1 —7—II 1
DEDICATED WATER RECYCLE SYSTEM f (fl1_r ' S
DISHWASHER
DRINKING FOUNTAIN
FOO D DIISPOSEAREA DRAIN sgsminstar_toson
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LKITCHEN AVATORY OINTERCEPTK( INTERIOR) ,IlIl 1'
ROOF DRAINill I oimsima
SHOWER STALL - 7-1,
SERVICE/MOP SINK ,
WATER HEATER ALL TYPES 1
IOI 11 1 lel 11
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INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY El OTHER TYPE OF INDEMNITY D BOND 0
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 0
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 compr.nceth alk-ertlnent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER'S NAME Joseph Ventresca LICENSE# 15742 SIGNATURE
MPD JPD CORPORATIOND# 3255 PARTNERS PO# • LLCD#MMIIIIM
COMPANY NAME South Shore Heating and Cooling ADDRESS 157 Whites Path
1 1
) c31 P 1 11CITY South Yarmouth STATE I MA ZIP 02664 TEL 508-398-69"t i
FAX 508-760-2681 CELL 508-360-5277 • EMAIL [Joe@southshoreheatingcooling.com
BUILON•DEPT '�
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ 0
FEE: $ PERM*It
PLAN REVIEW NOTES
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