HomeMy WebLinkAboutP-13-601 MASSACHUSETTS-UNIFORM APPLICATlONFOR ERM1TTO PERFORM-PLUMBING-TNORK-"`" —
tY '45 CITY Yarmouth MA DATE 03/18/13 PERMIT # 03 42(0
JOBSITE 172 North Main Street (SY) M#80 / P#134 OWNER'S NAME O'Donnell
POWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW; o RENOVATION: 0 REPLACEMENT: 0 Leo uo PLANS SUBMITTED: YES ❑ NO 0
FIXTURES-' - FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
EATHTUB
-CROSS CONNECTIONDEVICE ' r,
DEDICATED-SPECIAL VVASTE SYSTEM
`DEDICATED-GAMILISANDSYSTEM
DEDICATED)GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
'FOOD DISPOSER
1 FLOWbRTAREA DRAIN
IN TERCEPTORTINTERTOR) AI
TAV'ATORY A� Epj5 i7
al
ROOF DRAIN 3 i -
SHOWER STALL`
SERVICE I MOP SINK
TOILET
"URINAL
WASHING—MACHINE—CONNECTION
WATER HEATER ALLTYPES ...w.._ _.1. _ r.,. .,. . ._ .. _..
WA I LR PIPING
OTHER
IN,ORANCL LU hHAta
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY 0 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: OWNER ■ AGENT Q
SIGNATURE OF OWNER OR AGENT
'Thereby certify that all of the details and information I have submitted or entered regarding this application are true a.• - r- - o e .es o r y now e•ge an.
that all plumbing work and installations performed under the permit Issued for this application will be in complia. ertinent provi of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-15030 SIGNATURE
MP DB JP ❑ CORPORATION ®#C-2803 PAR HIP rn# LLC D#
COMPANY NAME:Hall Plumbing&Heating,Inc. DD OS:447 Old Chatham Road
f),/ r1? � g CITY:South Dennis STATE:MA [ZIP'0266 D TEL:508-385 9127FAX:508-385-6604 CELL MA 19 2013 EMAIL Halltechnician@comcastnet
C,�F-S0-6
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•
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
i
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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j—' _ 10fASSACHUSETTS IJMFORNIAPFEICATIONFORA PERMITTCYPERFORNfPE 110BTNGa WORC— .._,
I '._i -,_, I CITY Yarmouth MA DATE 03/18/13 PERMIT # P(3-. ea 6(
•_.p ,-
1 JOBSITE 172 North Main Street (SY) M#80 / P#134 OWNER'S NAME O'Donnell
Pj OWNER ADDRESS SAME TEL FAX '
TYPE OR I OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 0 RESIDENTIAL 0
PRINT I
L (,
CLEARLY I NEW: 0 RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO❑
o.o.
FIXTURES-. FLOOR 1 BSM 1 1 1 2 1 3 4 5 6 7 8 9 10 11 12 1 13 i 14 I
BATHTUB 1 I .
[CROSS CONNECTION DEVICE I 1 1 {
I DEDICATED SPECIAL WASTE SYSTEM I I
I DEDICATED GASTOWSAND SYS1 EM i i _
[DEDICATED GREASE SYSTEM j ( ; I
I DEDICATED GRAY WATER SYSTEM i ) ;
I DEDICATED WATER RECYCLE SYSTEM ' i i
1 DISHWASHER 1 j i t
%DRINKING FOUNTAIN : r
FOOD DISPOSER ( j II
FLOOR/AREA DRAIN 1 j I • I 1 i I
TNTERCEPTOW 1INTERIOR) 1 ; 1 j
- KITCHEN SINK B'AO ` f I
LAVATORY Arc 3 ti 1
I ROOF DRAIN B`l1 [_
SHOWER STALL 1 1 1
SERVICE / MOR SINK I j 1p j
ITOIL`
ET I ) I I 1-
URINAL j i 1
}
r WASHING MACHINE CONNECTION ,
WATER HEATER ALL TYPES. _ _ b..._. 1 1—4-1"-- �_� _ i _ f....__ I
WATER PIPING j 1 i I
OTHER I I I 1
1 t 1 11
I
INSURANLt LU4EH ACE: F
I have a current liability insurance policy or its substantial equivalent which meets the requirements.of MGL Ch.142. YES 9 NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY f OTHER TYPE OF INDEMNITY 0 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 ■ AGENT 0
SIGNATURE OF OWNER OR AGENT
'1ere•ycod' t a a o e•etassan. inormation ave su•mitte• orenere. regar•ing is app Ica ion are ue aro e •eso► y now e•gean.
that all plumbing work and installations performed under the permit issued for this application will be in comp ertinent prov '• of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-1503SIGNATURE
MP IRS JP ❑ CORPORATION ®#C-2803 PAR •30—'HIP II LLC ❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. 7 ?1 AADDIoS:447 Old Chatham Road
CITY:South Dennis STATE:MA I- ZIP:02660 J TEL:508-385-9127
FAX 508-385-6604 CELL - MA,R 1 9 2013 Es EMAIL Halltechnidan@comcasLnet
L Ce S75 474d .
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