HomeMy WebLinkAboutP-14-201 :t.%,, MASSACHUSt RS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . l
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,..._ " CITY Yarmouth MA , DATE 09105113 PERMIT # p!y—ao�
'r" x JOBSITE 6 Cypress Point Way(Yarmouth) M#91/P#74 OWNER'S NAME Broud u k'+
P OWNER ADDRESS SAME • •
TEL 508.394-0324FAX t,;
TYPE. OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 0 RESIDENTIAL x❑ 5.
PRINT
CLEARLY NEW:0 RENOVATION: 0 REPLACEMENT: ® PLANS SUBMITTED: YES ❑ NO❑
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FIXTURES-• FLOOR BSM 1 2 3 • 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I
IMOSSZOFINECTIONDEVICE I I 1
DEDICATED SPECIAL WASTE SYSTEM I I
DEDI
DEDICATED GREASE SYSTEM I S
DEDICATED GRAY WATER SYSTEM I
DEDICATED WATER RECYCLE SYSTEM ( I I 1
DISHWASHER _ .
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DRINKING FOUNTAIN E I I
FOOD DISPOSER II # 1
FLOOR/AREA DRAW I I IITIEFflICIIICI
20/ I 1
RPfCAEN 51NK ACEPI / I
LAVATORY I ,
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ROOF DRAIN ( 1a..,_.r _ > a. - _ . �E»�. ._
"SHOWER STALE—._._ # d�_. f
SERVICE / MOP SINK ? i ' 1 ,
• TOILET j ! I 1
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WASHING MACHINE CONNECTION • I 1
WATER HEATER ALLTYPES. ' _
WATER P I a I ! 1
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L TMEN tKA(.E
I have gweM t or its substantial equivalent which meets the requirements of MGL Ch.142. YES ® NOD ,
By:
IF YOU YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW. - - ., - -. - .. ..
UABIUTY INSURANCE POLICY ID 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 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 aactaate • o�owledge and •
that an performed plumbing work and installations perfoed under the permit Issued for this application will be In compliance . 'al Pe a . Isl. of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ASO
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PLUMBER'S NAME JamesPazalds LICENSE#PL-15030-M ' SIGNA,1'+
MP ®' JP ❑ CORPORATION ®#C-2803 PARTNER V I# ❑#
' 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 Hautedmidan@comcastnet ,
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